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And  now  remains, 
That  we  find  out  the  cause  of  this  effect ; 
Or,  rather,  say,  the  cause  of  this  defect ; 
For  this  effect,  defective,  comes  by  cause. 

Shakespeare. 


Care  and  Treatment 


of 


Epileptics 


WILLIAM    PRYOR    LETCHWORTH,  LL.D. 

EX-PRESIDENT   OF   THE   NEW   YORK  STATE   BOARD   OF   CHARITIES, 

EX-PRESIDENT  OF  THE   ELEVENTH   NATIONAL    CONFERENCE    OF   CHARITIES   AND    CORRECTION, 

AUTHOR   OF   "  THE   INSANE   IN   FOREIGN   COUNTRIES,"    "  CHILDREN   OF  THE   STATE," 

"  RELIEF  AND   REFORM,"    "  HOMES   FOR  HOMELESS  CHILDREN,"    ETC. 


ILLUSTRATED 


G.  P.  PUTNAM'S  SONS 

NEW  YORK  AND  LONDON 

Ube  fmicfeerbocfter  press 

1900 


.fo-lVat1! 


Copyright,  1899 

BY 

WILLIAM  PRYOR  LETCHWORTH 
Entered  at  Stationers'  Hall,  London 


"RC3?5" 


TXbe  fmicfcerbocher  press,  Dew  JPorft 


TO 

THE  MEMBERS   OF   THE   NATIONAL   ASSOCIATION 

FOR   THE   STUDY   OF   EPILEPSY 

AND    THE   CARE   AND   TREATMENT   OF   EPILEPTICS, 

WHOSE    HUMANITARIAN    PURPOSE   AND    SCIENTIFIC   AIMS 

ENLIST   MY   EARNEST   SYMPATHY, 

THIS 
WORK    IS    RESPECTFULLY   DEDICATED. 


PREFACE. 

At  the  National  Conference  of  Charities  and  Correction 
held  in  Nashville,  Tennessee,  in  1894,  the  author  of  this 
volume  read  a  paper  entitled  "  Provision  for  Epileptics;  " 
and  at  the  National  Conference  of  Charities  and  Correction 
held  in  Grand  Rapids,  Michigan,  in  1896,  he  read  a  paper 
on  the  "  Care  of  Epileptics,"  intending  to  show  the  advance 
that  had  been  made  in  the  care  of  this  class  during  the  inter- 
val between  the  two  conferences.  Neither  of  these  occasions 
afforded  an  opportunity  to  deal  with  the  subject  as  broadly 
as  it  demanded.  With  a  view  to  greater  elaboration,  and 
to  show  the  further  advance  that  has  been  made  in  the  care 
and  treatment  of  this  unfortunate  class,  the  present  work 
was  undertaken.  It  is  hoped  that  the  conclusions  drawn 
from  extended  observation  and  the  records  of  results 
achieved  by  those  who  have  had  practical  experience  in  the 
treatment  of  epilepsy,  may  prove  of  some  benefit  to  the 
sufferers  from  this  dread  disease. 

In  the  preparation  of  this  work  the  writer  has  received 
valuable  and  kindly  aid  from  many  of  the  persons  whose 
names  appear  in  the  following  pages,  and  from  others,  to 
whom  he  desires  to  make  grateful  acknowledgment. 

Glen  Iris,  Portage  P.  O.,  N.  Y.( 
September  2,  1899. 


CONTENTS. 


Preface  

I.     General  Principles 

II.     Ohio 

Ohio  Hospital  for  Epileptics 

III.  New  York       .... 

Craig  Colony 

IV.  Massachusetts,  New  Jersey,  Texas 

Massachusetts     .... 

Massachusetts  Hospital  for  Epileptics 
Hospital  Cottages  for  Children,  at  Baldwin- 
ville  ...... 

New  Jersey         ...... 

Texas  ....... 

V.     Pennsylvania,  Maryland,  Missouri    . 

Pennsylvania       ...... 

The  Pennsylvania   Epileptic    Hospital  and 

Colony  Farm  . 
The  Passavant  Memorial  Homes  for  the  Care 
of  Epileptics    ..... 

The  Pennsylvania  Training-School  for  Fee 
ble-Minded    Children 
Maryland    ....... 

The  Silver  Cross  Home  for  Epileptics 
Maryland  Asylum  and  Training-School  for 
Feeble-Minded 
Missouri      .... 

Emmaus 

vii 


PAGE 
V 

I 

63 

70 

87 
IOO 
136 
136 
139 

143 

145 
149 

153 
156 

l60 
l6l 
l6l 

I63 
I63 
l65 


Vlll 


CONTENTS. 


CHAPTER 

VI. 


VII. 


VIII. 


IX. 


,  Virginia,  Canada 


California,  Michigan,  Minnesota,  Wisconsin, 
West  Virginia 

California    . 

Michigan     . 

Minnesota  . 

Wisconsin   . 

West  Virginia 
Iowa,  Illinois,  Connecticut 

Iowa   .... 

Illinois 

Connecticut 

Virginia 

Canada 
England 

Home  for  Epileptics,  Maghull 

National  Society  for  the  Employment  of 
leptics 

The  Meath  Home  of  Comfort 

St.  Luke's  Home 
Continental  Countries 

Wuhlgarten 

Switzerland 

Bethel  Colony,  near  Bielefeld 
Index      


Epi 


168 
168 
176 
177 
178 
179 
181 
181 
182 
184 
184 
188 
189 
191 

195 
204 
207 
209 
216 
222 
226 
241 


LIST  OF  ILLUSTRATIONS. 


Ohio  Hospital  for  Epileptics         .         .         Frontispiece 

Cottage  Groups  at  Alt-Scherbitz        ....       34 

Ohio  Hospital  for  Epileptics: 

Buildings  for  Men 74 

Buildings  for  Women        ......       76 

dlning-halls,  kltchen,  and  bakery  ...  78 
Residence,  Laundry,  and  Schoolhouse  .  .  .  80 
Department  for  the  Insane    .....       80 

Craig  Colony: 

Cashaqua  Creek ioo 

Map  of  Craig  Colony  Estate  ....     102 

Main  Group  of  Buildings  .....  104 
Rear  View  of  Main  Group  of  Buildings  .  .  106 
Administration  Building  .....     108 

Peterson  Hospital  .......     108 

Letchworth  House .110 

Hoyt  Cottage .110 

Temporary  Residence  of  Superintendent       .         .     112 
Industrial  Building         .         .         .         .         .         .112 

Tall  Chief  Cottage         .         .         .         .         .         .112 

West  Group  of  Buildings 114 

Cottage  Group  for  Women  and  Children  .  .116 
Central  Buildings  of  Women's  Group  .  .  .118 
Cottages  for  Working  Patients     ....     120 

Steward's  Residence 120 

Railway  Station  and  Men's  Industrial  Building  .     120 
Farmstead  Group     .......     122 

Cottages  for  Officers.  Water-tower  .  .  .  124 
Patients  Hoeing  Corn 124 


LIST  OF  ILLUSTRATIONS. 


Epi- 


Craig  Colony — {Continued}  : 

Garden  and  Lake     . 

Patients  Digging  Potatoes 

Patients  Clearing  Land 

Epileptics  Building  a  House 

Patients  Gathering  Apples 

Patients  Making  Brick   . 

Sloyd  School  for  Boys    . 

Patients  Making  Straw  Mats 

Sloyd  School  for  Girls   . 

Patients  in  Lumber  Camp 

Dumb-bell  Drill 

Seneca  Indian  Girl  in  Costume 

Girls  Dancing  at  Entertainment  . 
Ground  Plan  of   Massachusetts   Hospital  for 

leptics 

Hospital  Cottages  for  Children  at  Baldwinville: 

General  View  of  the  Estate  .... 

Hospital  Cottages 

Schoolhouse     .         .         

Pennsylvania  Epileptic  Hospital  and  Colony  Farm 

Administration  Building  and  Cottages 

View  of  Colony  Farm 

Passavant  Memorial  Homes: 

General  View  of  Homes 

Making  Apple-butter 
Emmaus,  Marthasville,  Mo. 
California  Home: 

Department  for  Epileptic  Children 

Boys'  Kindergarten  Class 

Girls'  Kindergarten  Class 
Maghull  Home: 

Manor  House  for  Women 

Building  for  Men     . 
Chalfont  St.  Peter: 

General  View  of  Colony 

'Eleanor  House 

Hall  of  Eleanor  House  . 

Passmore  Edwards  House 

Victoria  House 


LIST  OF  ILLUSTRATIONS.  XI 

PAGE 

Meath  Home  of  Comfort 204 

Lauderdale  Ward    .......  206 

Ground  Plan  of  Wuhlgarten  Asylum  .         .         .         .218 

Zurich  Asylum 222 

Bethel  Colony  near  Bielefeld 226 

Pastor   von    Bodelschwingh    with    Theological 

Candidates    ........  228 

Sisters  of  Bethany  .......  230 

Bird's-eye  View  of  Bethel  Colony  and  Branch 

Colony  of  Wilhelmsdorf      .....  232 

Ebenezer  .........  234 

Bethel 234 

Mamre       .........  234 

Arimathea         ........  236 

Brick  and  Tile  Works 236 

Rehoboth           . 236 


CARE    AND    TREATMENT    OF 
EPILEPTICS. 


CHAPTER  I. 
GENERAL  PRINCIPLES, 

IN  the  enlarged  sphere  of  the  charities  of  this  day  of  ex- 
panding philanthropy  it  may  be  said  that  the  claims  of 
every  afflicted  class  except  the  victims  of  the  mysterious 
disease  of  epilepsy  are  fairly  recognized.  The  insane,  the 
feeble-minded,  the  deaf  and  dumb,  the  blind,  the  paralyzed, 
defective  children,  and  other  dependent  classes  receive 
sympathetic  attention.  More  has  been  done  for  epileptics 
in  the  Continental  countries  of  Europe  than  elsewhere.  A 
beginning  has  been  made  in  caring  for  them  properly  in 
England,  and  something  has  been  accomplished  for  them  in 
America ;  but  the  great  mass  of  sufferers  are  still  left  without 
that  special  care  which  an  enlightened  civilization  demands. 
Like  insanity,  epilepsy  in  ancient  times  was  regarded  with 
superstitious  awe,  and  the  belief  was  generally  held  that  the 
subject  of  the  disease  was  possessed  by  a  demon  from  which 
he  vainly  strove  to  free  himself,  or  was  suffering  punishment 
inflicted  by  a  deity  whose  anger  he  had  incurred.  Hippocra- 
tes, however,  did  not  accept  this  theory,  and  boldly  asserted 
that  the  disease  originated  from  natural  causes  and  that 
men  regarded  it  as  of  divine  origin  purely  from  ignorance. 

i 


2  CARE  AND  TREATMENT  OF  EPILEPTICS. 

Down  to  a  comparatively  recent  period  some  of  the 
numerous  remedies  prescribed  for  curing  epilepsy  were  so 
absurd  that  it  seems  strange  they  should  have  been  resorted 
to  by  persons  of  influence  and  reputed  intelligence.  The 
treatment  of  the  disease  appears  to  have  embraced  almost 
every  imaginable  remedy,  including  the  most  extraordinary 
and  repulsive  mixtures.  Among  these  may  be  mentioned, 
by  way  of  illustration,  a  prescription  compounded  of  cer- 
tain roots  and  the  skull  of  a  criminal  who  had  suffered  capi- 
tal punishment.  This  was  a  popular  remedy  as  late  as  the 
eighteenth  century.  A  preparation  of  earthworms  and  a 
human  skull,  prescribed  as  a  remedy  by  the  physician  of 
King  William  III.  ;  rum  in  which  snakes'  heads  had  been 
steeped ;  wheat  flour  mixed  with  dew  gathered  on  the 
morning  of  Saint  John's  Day  and  made  into  a  cake;  and  a 
powder  made  from  the  burned  remains  of  magpies ; — these 
were  held  at  one  time  to  be  valuable.  As  a  preventive  of 
epilepsy,  coral  powder  mixed  with  nurse's  milk,  and  given 
to  an  infant  soon  after  birth,  was  a  common  prescription. 

Progress  in  Scientific  Knowledge. — From  the  dawn  of 
history  the  disease  has  been  enveloped  in  mystery,  a  mystery 
which  is  not  even  now  dispelled,  and  into  which  it  may  be 
said  the  light  of  science  has  not  practically  penetrated. 
Only  during  the  past  twenty  years  has  much  advance  been 
made  in  scientific  knowledge  of  the  subject,  and  only  within 
a  period  of  between  thirty  and  forty  years  has  any  con- 
siderable effort  been  made  to  ameliorate  the  condition  of 
epileptics.  So  high  an  authority  as  Dr.  Ira  Van  Gieson 
says:  "  All  the  facts  which  the  pathological  anatomist  and 
the  physiological  chemist  have  gained  in  the  study  of  this 
dire  malady  give  no  explanation  of  the  process  that  gives 
rise  to  the  epileptic  phenomena."  After  discussing  various 
theories  as  to  the  causes  of  epilepsy,  Dr.  Wildermuth,  of 


CHARACTERISTICS  OF  EPILEPSY.  3 

Stuttgart,  writes:  "  We  should  still  be  in  ignorance  of  the 
real  nature  of  epilepsy  even  if  we  knew  the  cerebral  origin 
of  the  separate  attacks.  Anatomic  investigation  has  as  yet 
shown  us  no  lesion  which  can  be  deemed  characteristic  for 
epilepsy. 

Characteristics  of  Epilepsy. — At  the  outset  it  may  be 
proper  to  refer  briefly  to  the  clinical  characteristics  of 
epilepsy.  A  description  of  its  manifestations  is  thus  set 
forth  by  Dr.  Frederick  Peterson : 

"  Epilepsy  is  a  functional  disease  of  the  brain,  in  which 
the  chief  feature  is  a  sudden  loss  of  consciousness.  The 
loss  of  consciousness  may  be  complete  or  incomplete.  Gen- 
erally it  is  accompanied  by  spasms.  The  type  of  epilepsy 
most  familiar  to  laymen  is  that  called  by  physicians  grand 
mal.  The  patient  falls  in  an  unconscious  state,  often  giving 
a  sharp  cry  as  he  does  so,  and  as  he  lies  prone  goes  into  a  con- 
vulsion lasting  a  few  moments  or  longer,  rarely  more  than  five 
minutes.  The  epileptic  has  such  '  seizures  '  or  '  attacks  '  of 
spasms  at  variable  intervals,  sometimes  frequently  every  day, 
sometimes  only  once  weekly  or  once  monthly,  and  sometimes 
only  two  or  three  times  in  a  year.  There  is  no  regularity 
in  their  onset,  and  this  unexpectedness  or  unpreparedness 
is  one  of  the  most  trying  features  of  the  malady.  The  at- 
tack comes  like  a  flash  of  lightning  from  a  clear  sky,  con- 
stituting therefore  a  grave  danger,  in  that  the  patient  may 
be  near  a  declivity,  over  deep  water,  close  to  a  fire,  or  in 
some  other  position  where  a  seizure  may  lead  to  serious 
injury  or  accidental  death.  After  the  spasms  have  passed, 
the  patient  is  in  a  somewhat  dazed  state,  and  is  apt  to  sleep 
for  a  half-hour  or  so.  Then  he  rises  and  goes  about  his 
duties  as  before.  A  less  common  and  familiar  form  of 
epilepsy  is  that  known  to  physicians  as  petit  mal,  or  light 
attack.     In  this,  consciousness  is  also  lost,  but  ordinarily 


4  CARE  AND  TREATMENT  OF  EPILEPTICS. 

only  for  a  second  or  two.  The  patient  does  not  fall,  as  a 
rule,  and  has  no  spasm,  but  his  face  may  twist  to  one  side, 
or  his  hands  perform  some  automatic  act. 

"  Not  infrequently  epileptics  have  some  warning  of  an  ap- 
proaching attack.  They  have  a  queer  feeling  in  the  stomach, 
chest,  or  throat,  a  dizziness  in  the  head,  a  flash  of  light  be- 
fore the  eyes,  a  sensation  in  one  of  the  arms  or  legs,  a  ringing 
in  the  ears,  or  some  other  sign  with  which  they  become  famil- 
iar as  the  warning  of  the  onset  of  a  fit.  Occasionally  this 
warning  is  sufficiently  prolonged  .for  the  patient  to  call  to 
some  one  or  to  seek  a  place  to  lie  down.  As  the  patient  falls 
his  face  is  pale  and  his  pupils  large,  but  when  the  spasm  be- 
gins, the  face  grows  dusky  and  red  and  the  veins  distend, 
as  the  blood  rushes  into  the  head.  The  breathing  becomes 
slow  and  difficult,  owing  to  the  spasm  in  the  muscles  of 
the  chest ;  and  noisy,  snoring,  or  stertorous  from  spasm  in 
the  muscles  of  the  throat.  The  teeth  are  clenched  tightly, 
and  the  saliva  in  the  mouth  is  made  into  froth  at  the  lips  by 
the  struggle  for  air.  If  the  tongue  is  caught  between  these 
clenched  teeth,  it  is  apt  to  be  bitten  and  the  froth  is  bloody. 
In  very  serious  cases  these  spasms  may  be  so  severe  as  to  frac- 
ture the  bones,  dislocate  the  jaw  or  the  shoulder,  or  cause 
rupture  of  the  engorged  blood-vessels  in  the  flesh  or  in  the 
brain.  Frequently  there  is  involuntary  evacuation  of  the 
bladder  or  bowels.  Some  patients  have  both  kinds  of  at- 
tacks, mild  ones  sometimes,  and  severe  ones  at  others.  Oc- 
casionally there  will  be  a  sudden  outbreak  of  a  long  series 
of  severe  attacks  without  an  appreciable  interval  between 
them,  hundreds  of  seizures  in  a  few  hours.  This  state  is 
known  as  the  status  epilcpticus,  and  in  this  the  patient  may 
die. 

"  There   is  a  peculiar  automatic   or  subconscious   state 
observed   at  times  in  epileptics,   either  before  or  after  an 


CHARACTERISTICS  OF  EPILEPSY.  5 

attack.  The  patient  acts  as  if  he  were  in  a  dream.  For 
the  time  being  he  is  actually  a  somnambulist,  and  may  per- 
form quite  complicated  acts  without  consciousness  of  what 
he  is  doing.  Since  such  acts  may  be  at  times  harmful  to 
himself  or  others,  this  state  is  fraught  with  danger. 

"  Some  10  per  cent,  of  all  epileptics  become  so  insane  as 
to  require  supervision  at  home  or  in  asylums.  Hence  the 
epileptic  neurosis  in  an  individual  renders  him  about  thirty 
times  more  liable  to  insanity  than  if  he  were  normal." 

Dr.  Wildermuth  describes  the  different  phases  of  epilepsy 
in  the  following  language : 

"  The  name  epilepsy  is  used  to  express  various  conditions 
which,  pathologically  considered,  are  entirely  unlike.  We 
must  differentiate  between — 

"  I.  True  Epilepsy  {Epilepsia  vera)  —  Idiopathic  Epi- 
lepsy. 

' '  2.  Epilepsy  following  poisoning,  especially  by  alcohol, 
which  presents  similar  clinical  symptoms. 

"  3.  Cortical  Epilepsy  (Epilepsia  corticalis)t  resulting 
from  local  disease  of  the  motor  cortical  area.  A  frequent 
form  of  Cortical  Epilepsy  is  that  which  follows  infantile 
polioencephalitis. 

"  4.  Reflex  Epilepsy,  which  has  its  origin  in  the  morbid 
irritation  of  a  peripheral  nerve. 

Of  these  diseases  True  Epilepsy  occurs  most  frequently 
— in  about  80  per  cent,  of  all  cases.  The  next  in  fre- 
quency of  occurrence  is  the  epilepsy  following  polioen- 
cephalitis— in  14  per  cent,  of  all  cases.  The  other  forms  of 
Cortical  Epilepsy  are  seen  less  frequently,  and  Reflex 
Epilepsy  is  a  rare  disease. 

'  The  main  symptoms  of  True  Epilepsy  to  be  noted  are 
periodic  attacks  of  a  morbid  change  in  consciousness,  often 
accompanied  by  tonic  and  clonic  muscular  spasms. 


6  CARE  AND  TREATMENT  OF  EPILEPTICS. 

In  the  majority  of  cases  epilepsy  leads  to  permanent 
mental  disturbances,  consisting  of  intellectual  weakness  of 
all  degrees,  from  a  slight  diminution  of  mental  power  to 
complete  idiocy.  Not  infrequently  this  is  accompanied  by 
morbid  changes  of  character.  Severe  forms  of  moral  per- 
version occur  less  often  than  is  commonly  supposed.  Per- 
manent decrease  in  intellectual  and  moral  tone  is  expressed 
in  the  term  Epileptic  Degeneration. 

In  addition  to  permanent  degeneration,  there  occur  in 
epileptics  more  or  less  acute  mental  disturbances.  The 
most  important  point  in  connection  with  these,  according 
to  Siemerling,  is  a  dream-like  state  of  consciousness  of  vary- 
ing duration  and  form,  with  or  without  delusions,  memory 
being  lost  or  only  clouded.  These  '  twilight  states  '  are 
especially  feared  because,  while  they  endure,  deeds  of  vio- 
lence are  not  infrequently  committed.  These  acute  psychi- 
cal disturbances  may  follow  pronounced  epileptic  attacks  or 
occur  in  their  stead  as  equivalents.  In  rare  cases  they  are 
the  only  manifestations  of  the  disease.  We  observe  in 
epileptics  also  acute  psychical  disturbances  without  change 
of  consciousness.  These  always  appear  in  connection  with 
attacks,  either  as  a  morbid  mood  which  lasts  unchanged 
during  a  series  of  attacks,  or  which  is  different  before  the 
attack  from  what  it  is  afterward." 

It  is  fortunate  that  the  form  of  epilepsy  designated  as 
"  psychical  "  epilepsy  is  not  of  common  occurrence.1 

The  records  of  disordered  consciousness  show  many 
strange  experiences.  One  of  these,  taken  from  the  Medical 
Minutes  of  the  Craig  Colony,  is  an  apt  illustration. 

A  young  civil  engineer,  who  later  in  life  became  a  loco- 

1 A  remarkable  case  of  psychical  epilepsy  which  came  under  the  personal 
observation  of  Mr.  F.  B.  Sanborn,  of  Massachusetts,  was  described  by  him  at 
the  American  Social  Science  Association  in  1897,  and  reported  in  the  Decem- 
ber Transactions  of  that  year. 


CHARACTERISTICS  OF  EPILEPSY.  J 

motive  engineer,  fell  a  victim  to  this  dangerous  form  of 
epilepsy  while  at  work  on  the  Brooklyn  Elevated  Railway, 
where  he  was  employed  for  three  or  four  years,  until  dis- 
charged on  account  of  this  malady.  One  day  he  was  seized 
with  a  fit  while  travelling  on  the  railway  to  Newburg. 
Coming  to  a  station,  he  deliberately  left  the  train,  walked 
into  the  telegraph  office,  and,  being  a  strong  man  physically, 
managed  to  eject  the  two  operators  who  were  on  duty,  and 
who  hastily  fled.  Knowing  something  of  telegraphy,  and 
having  the  room  entirely  to  himself,  he  proceeded  to  send  a 
message  to  a  man  in  the  main  office  with  whom  he  was  ac- 
quainted. After  copying  the  message  he  had  sent  and 
placing  the  copy  in  his  pocketbook,  he  arose,  locked  the 
door  of  the  room,  and  went  to  his  home  in  Newburg,  taking 
the  key  with  him.  When  aroused  by  a  policeman  next 
morning  he  knew  nothing  of  what  had  occurred.  He  re- 
membered the  attack  coming  on,  but  could  recall  nothing 
of  what  happened  afterward,  nor  could  he  tell  how  he  man- 
aged to  get  home.  The  key  in  his  pocket  and  also  the  copy 
of  the  message  were  indubitable  evidence  of  the  truth  of  the 
officer's  statement.  Mental  automatism,  especially  when 
a  patient  is  addicted  to  bromide,  imparting  as  this  does  a 
whiskey-like  odor  to  the  breath,  is  frequently  confounded 
with  intoxication.  To  strengthen  the  resemblance  the 
victim's  manner  is  frequently  quarrelsome,  abusive,  and  in- 
sulting. This  unfortunate  engineer  had  been  so  frequently 
arrested  for  drunkenness  that  his  friends  had  a  card  fastened 
under  his  coat  inscribed,  "  This  man  is  an  epileptic.  Send 
him  home. "  This  was  signed  by  a  reputable  physician.  In 
earlier  life  he  had  been  a  hard  drinker.  He  is  forty-three 
years  old,  married,  and  the  father  of  six  children,  two 
of  whom,  sad  to  relate,  were  born  after  his  epileptic 
seizures. 


8  CARE  AND  TREATMENT  OF  EPILEPTICS. 

Age  at  which  Disease  Develops. — From  statistics  carefully 
compiled  by  different  authorities  the  important  fact  has 
been  demonstrated  that  epilepsy  is  essentially  a  disease  of 
the  young.  It  is  equally  apparent  that,  unless  early  efforts 
are  made  to  arrest  the  disease,  mental  and  physical  de- 
terioration are  inevitable. 

Dr.  Hare  sums  up  the  conclusions  of  a  number  of  distin- 
guished authorities  as  follows:  "  Three  fourths  of  all  cases 
of  true  idiopathic  epilepsy  begin  under  twenty  years  of  age, 
and  nearly  half  of  all  cases  between  ten  and  twenty,  the 
greatest  number  being  at  fourteen,  fifteen,  and  sixteen. 
One  eighth  of  all  cases  begin  during  the  first  three  years  of 
life,  but  after  twenty  the  number  falls  very  low.  .  .  . 
Of  1288  cases  collected  by  nine  French  authorities,  in  486, 
or  over  one  third,  the  disease  began  between  the  tenth  and 
twentieth  years.  Hasse,  in  the  1000  cases  collected  by  him, 
found  that  75  per  cent,  were  at  the  onset  under  twenty 
years  of  age.  According  to  Nothnagel,  the  great  majority 
of  cases  occur  between  seven  and  seventeen  years,  not  only 
in  hereditary  epilepsy,  but  in  the  other  forms." 

It  is  the  experience  of  Dr.  Wildermuth  that  epilepsy  de- 
velops in  34  per  cent,  of  cases  between  the  ages  of  one 
and  five  years;  in  75.5  per  cent,  of  cases,  between  one  and 
fifteen  years;  in  82.2  per  cent,  of  cases,  between  one  and 
twenty  years.  For  the  period  between  one  and  twenty 
years,  Tigges,  Pelmann,  and  Mandel  give  from  70  per  cent, 
upward. 

Of  the  234  patients  received  into  the  Bethel  Colony  at 
Bielefeld  during  the  year  1895,  it  is  stated  that  145,  or  about 
62  per  cent.,  suffered  from  attacks  before  they  were  ten 
years  of  age,  and  178,  or  j6  per  cent.,  before  they  were 
fifteen. 

As  the  result  of  a  study  of  342  cases  coming  under  his  care 


A  GE — HE  RED  IT  Y.  9 

and  437  cases  that  had  recovered  before  coming  under  his 
observation,  Dr.  A.  W.  Wilmarth,  Superintendent  of  the 
Wisconsin  Home  for  the  Feeble-Minded,  found  that  "  when 
the  first  attack  of  convulsions  occurred  before  the  third  year 
of  life,  in  a  little  more  than  half  the  children  attacked  they 
ceased  before  the  age  of  puberty.  When  the  spasms  persist 
or  begin  after  puberty,  recoveries  are  rare." 

From  the  opening  of  the  Ohio  State  Hospital  for  Epilep- 
tics in  1893  to  November  30,  1898,  there  were  admitted  to 
that  institution  1295  patients.  The  ages  at  which  they 
suffered  from  the  first  attack  of  epilepsy  are  thus  given : 

In  infancy 339 

Between  five  and  ten  years 194 

ten  and  fifteen  years 296 

fifteen  and  twenty  years 173 

twenty  and  thirty      "      159 

"         thirty  and  forty  "     61 

"         forty  and  fifty  "     20 

Over  fifty  years 14 

Unknown 39 

Heredity. — As  to  the  causes  producing  epilepsy  there  is 
an  interesting  field  yet  to  be  explored.  Those  arising  from 
heredity  are  numerous;  in  fact,  this  source  of  epilepsy, 
idiocy,  and  crime  has  reached  threatening  proportions. 
The  vast  number  of  degenerate  persons  that  now  burden 
society,  whose  defective  organization  is  traceable  to  hered- 
itary causes,  and  who  continue  to  transmit  their  weaknesses, 
— physical,  mental,  and  moral, — presents  a  difficult  and  im- 
portant problem  to  social  scientists. 

In  tracing  the  histories  of  imbecile  children,  Dr.  G.  H. 
Knight,  Superintendent  of  the  Connecticut  School  for  Im- 
beciles, found  that  epilepsy  existed  of  itself  or  as  a  com- 
plication in  over  60  per  cent,  of  the  cases  examined.      He 


IO  CARE  AND  TREATMENT  OF  EPILEPTICS. 

expresses  the  opinion  that  epilepsy  is  one  of  the  most  active 
factors  in  the  result  called  imbecility.  As  illustrating  the 
evils  resulting  from  indiscriminate  marriages,  Dr.  Knight 
gave  the  following  facts  in  1886:  "  From  my  own  knowledge 
I  can  cite  the  case  of  an  epileptic  woman  who  became  the 
mother  of  fifteen  defective  children.  Eight  died  in  infancy 
from  lack  of  vitality,  two  inherited  the  epilepsy,  two  were 
fairly  teachable  imbeciles,  and  the  other  three  had  sufficient 
intelligence  to  marry  and  reproduce,  according  to  the  laws 
of  heredity,  the  mother's  experience.  This  instance  is  only 
another  proof  of  what  we  must  all  believe — namely,  that 
like  produces  like;  and,  therefore,  as  a  natural  sequence  of 
things,  epileptics  in  the  majority  of  cases  must  produce 
defective  children." 

Dr.  J.  B.  Maxwell,  of  Illinois,  says:  "  I  believe  heredity 
has  largely  to  do  with  epilepsy.  In  a  careful  examination 
of  the  family  history  of  epileptics,  a  very  large  percentage 
of  parental  relatives,  perhaps  even  66f ,  will  be  found  suffer- 
ing from  some  nervous  affection  or  eccentricity,  one  third 
from  insanity." 

Since  the  opening  of  the  Ohio  Hospital  for  Epileptics, 
a  study  into  the  causes  of  epilepsy  has  been  pursued 
with  painstaking  care.  Of  the  1295  patients  admitted 
between  November  30,  1893,  and  November  30,  1898, 
it  was  ascertained  that  232,  or  about  18  per  cent., 
had  relatives  who  were  subject  to  epilepsy,  and  that 
103,  or  about  8  per  cent.,  had  relatives  who  were 
subject  to  insanity.  In  a  large  percentage  of  cases 
the  relationship  was  that  of  parent,  grandparent,  uncle, 
aunt,  brother,  or  sister;  in  some  instances  it  was  more 
remote. 

The  condition  of  the  offspring  of  62  male  and  74  female 
epileptics  is  given  by  Echeverria,  as  follows:    Of  535  children 


HEREDITY.  II 

4#  were  still-born. 
36  <fo  died  in  infancy  from  convulsions. 

5  to  "      other  diseases. 

15  $  became  epileptic. 

2$  became  insane. 

7  $  suffered  from  paralysis. 

9$  became  hysterical. 

1  $  became  choreic. 

1  #  had  strabismus. 
20^  were  normal. 

Dr.Wildermuth  says :  ' '  However  much  opinions  may  vary 
as  to  the  nature  and  actual  causes  of  epilepsy,  it  is  certain 
that  in  the  majority  of  cases  (in  at  least  60  per  cent.)  the  dis- 
ease develops  as  a  result  of  morbid  hereditary  tendencies." 

All  familiar  with  rural  life  are  aware  of  the  care  agricul- 
turists exercise  to  mate  animals  in  such  a  way  as  to  secure 
vigorous  progeny,  comely  in  shape,  docile  and  intelligent ; 
but  in  the  procreation  of  the  human  species  the  fact  that  the 
condition  of  the  body  may  determine  whether  a  life  be  one 
of  wretchedness  or  usefulness  is  but  lightly  considered  or 
entirely  overlooked.  The  same  man  who  has  exercised 
thoughtful  discretion  in  mating  dumb  animals  will  approve 
the  marriage  of  his  son  or  daughter  under  conditions  that 
will,  in  the  judgment  of  his  physician,  result  in  degenerate 
offspring.  Pecuniary  considerations,  advantages  of  social 
position  or  title,  outweigh  everything  else,  and  there  is 
brought  into  the  world  through  pride,  ambition,  or  merce- 
nary motives  degenerate  progeny.  One  would  suppose  that 
the  development  of  a  high  physical,  mental,  and  moral 
standard  of  the  human  species  would  be  considered  in  every 
marriage.  On  the  contrary,  it  is  usually  a  matter  receiving 
no  thought  whatever.  Unhappy  results  from  this  indiffer- 
ence are  familiar  to  all  and  are  constantly  occurring  in  the 
history  of  the  great  as  well  as  the  humble. 


12  CARE  AND  TREATMENT  OF  EPILEPTICS. 

It  is  the  opinion  of  Dr.  Wildermuth  that  every  physician 
should  on  principle  advise  against  the  marriage  of  epileptics, 
even  in  the  case  of  light  forms  of  the  disease.  He  says: 
"  It  is  a  popular  belief  that  marriage  acts  as  a  curative  agent 
in  epilepsy ;  this  is  not  the  case.  Epilepsy  has  never  been 
cured  or  even  improved  by  marriage,  and  such  unions 
always  result  disastrously  in  one  way  or  another." 

In  the  Twenty-fifth  National  Conference  of  Charities  and 
Correction,  Dr.  James  C.  Carson,  Superintendent  of  the 
Syracuse  State  Institution  for  Feeble-Minded  Children, 
gave  expression  to  the  following  views  upon  this  subject: 

Considering  the  vast  import  of  insanity,  epilepsy,  and 
feeble-mindedness  in  relation  to  their  own  and  other  forms 
of  degeneracy,  a  law  prescribing  some  extraordinary  penalty 
should  be  upon  the  statute-books  of  every  State  for  the 
seduction  of  any  insane,  epileptic,  or  feeble-minded  woman ; 
and,  further,  every  State  in  the  Union  ought  surely  to  pro- 
hibit the  marriage  of  any  person  of  either  sex  belonging  to 
any  one  of  these  classes." 

Legislation  to  Arrest  Degeneracy. — The  opinion  is  growing 
that  legislative  interference  should  be  invoked  to  check  the 
evils  of  degeneracy.  In  1895  an  act  was  passed  by  the 
General  Assembly  of  Connecticut,  prohibiting,  under  pen- 
alty of  three  years'  imprisonment,  the  intermarriage,  where 
the  woman  is  under  forty-five  years  of  age,  of  a  man  or 
woman,  either  of  whom  is  epileptic,  imbecile,  or  feeble- 
minded, or  the  cohabitation  of  a  man  with  any  female  under 
forty-five  (not  being  his  lawful  wife)  who  is  thus  afflicted. 

Pennsylvania  has  recorded  the  following  act  upon  its 
statute-books: 

No  insane  or  feeble-minded  person  and  no  person  who 
from  natural  causes  as  distinguished  from  accidental  causes 
shall  have  been  insane  in  the  past,  and  no  person  who  shall 


LEGISLA  TION — CLIMA  TE — RA  CE.  1 3 

hereafter  have  been  twice  convicted  of  felony  as  defined  by 
the  laws  of  the  commonwealth,  shall  be  capable  of  marriage 
in  wedlock,  and  any  clergyman  or  civil  officer  who  shall 
knowingly  solemnize  such  marriage,  and  any  person  who 
shall  knowingly  assist  in  procuring  or  abetting  the  same,  in- 
cluding the  parties  to  such  marriage,  shall  be  guilty  of  a 
misdemeanor  and  shall  be  subject  to  imprisonment  for  six 
months  and  a  fine  of  five  hundred  dollars,  both  or  either,  at 
the  discretion  of  the  judge  before  whom  the  offence  shall  be 
tried." 

It  may  take  time  to  educate  the  public  mind  to  the  im- 
portance of  enforcing  such  statutes,  but  the  necessity  of 
such  would  seem  to  be  obvious. 

Climatic  Influences. — As  to  the  effect  of  climate  upon  the 
disease,  it  is  asserted  that  the  Alpine  and  sub-Alpine  de- 
partments of  France  furnish  an  unusual  number  of  subjects, 
and  that  in  certain  northern  countries — Greenland,  Scan- 
dinavia, and  the  region  along  the  Baltic — epilepsy  occurs 
with  special  frequency,  but  there  are  no  satisfactory  statis- 
tics to  verify  the  latter  statement.  It  is,  however,  estab- 
lished that  epilepsy  exists  in  all  countries  and  among  all 
peoples. 

Racial  Differences. — The  extent  to  which  different  races 
are  affected  by  epilepsy  is  a  question  to  which  some  atten- 
tion has  been  given.  While  the  colored  population  of  the 
South  has  until  recent  years  been  less  subject  to  insanity 
than  the  white  population,  eminent  Southern  physicians 
tell  us  that  the  same  is  not  true  as  regards  epilepsy.  Of 
about  800  insane  negroes  cared  for  in  the  Central  State 
Hospital  at  Petersburg,  Virginia,  about  100  were  epileptics, 
a  much  larger  proportion  than  is  found  in  similar  institutions 
for  white  people. 

In  the  Territory  of  New  Mexico  the  native  Mexicans 


14  CARE  AND  TREATMENT  OF  EPILEPTICS. 

are  subject  to  epilepsy  far  more  than  American  or  English- 
speaking  peoples."  ' 

Ratio  of  Epileptics  to  Population. — It  is  not  possible  to 
state  with  accuracy  the  number  of  epileptics  in  different 
States  and  countries,  for  the  reason  that  statistics  re- 
specting them  have  been  collected  only  within  certain 
areas  of  territory,  and  such  statistics  as  are  gathered  fall 
short  of  the  real  number,  owing  to  the  reluctance  of 
those  suffering  from  the  malady  and  their  friends  to  re- 
veal their  affliction,  and  to  the  fact  that  mild  cases  are 
seldom  recognized. 

In  1897,  Dr.  F.  M.  Powell,  Superintendent  of  the  Iowa 
Institution  for  Feeble-Minded  Children,  endeavored  to  as- 
certain the  number  of  epileptics  in  Iowa.  There  were 
reported  to  him  by  800  different  physicians  with  whom 
he  was  in  special  correspondence  2446  epileptics.  In  70 
out  of  90  poorhouses  *  heard  from  there  were  191,  and 
in  hospitals  for  the  insane  and  institutions  for  the  feeble- 
minded there  were  360.  He  concludes  that  a  conservative 
estimate  of  the  number  of  epileptics  in  Iowa  would  be  3360, 
or  1  to  every  600  of  the  population.  Dr.  Peterson  estimates 
the  ratio  of  epileptics  in  New  York  State  as  1  to  every  500 
of  the  population.  Dr.  John  Morris  concludes  that  there  is 
not  less  than  1  to  every  500  of  the  population  in  Maryland, 
including  children  and  adults.  Dr.  Wm.  F.  Drewry,  who, 
during  a  few  years  past,  has  endeavored  to  arrive  at  the 
number  of  epileptics  in  Virginia,  concludes  that  there  are 
3000  in  that  State.  This  is  a  ratio  of  a  fraction  less  than  2 
to  1000  on  the  basis  of  the  last  census.  Mr.  G.  Penn  Gas- 
kell,  Secretary  of  the  National  Society  for  the  Employment 

1  Rev.  Mary  J.  Borden,  State  Corresponding  Secretary  National  Conference 
of  Charities  and  Correction. 

2  Poorhouses,  almshouses,  and  county  infirmaries  are  used  throughout  these 
pages  as  synonymous  terms. 


RATIO    TO  POPULATION.  1 5 

of  Epileptics,  estimates  the  ratio  to  population  in  England 
to  be  about  the  same. 

From  records  made  in  the  examination  of  over  20,000  re- 
cruits at  Aaren  in  Switzerland  in  1887,  it  appears  that  2.42 
to  1000  were  rejected  because  they  were  epileptics.  An  aver- 
age of  the  examinations  for  the  years  1889-90-91  shows  that 
2.57  to  1000  of  those  examined  were  rejected  for  the  same 
reason.  Statistics  collected  from  Mecklenburg-Schwerin 
give  the  ratio  to  population  as  1.5  to  1000.  Lepointe  has 
estimated  the  ratio  in  the  Department  de  l'Allier,  France, 
as  1. 169  to  1000.  In  Belgium,  Morel  gives  the  ratio  of 
epileptics  to  population  as  1  to  1000.  Pastor  von  Bodel- 
schwingh  fixes  the  ratio  in  Prussia  as  1.5  to  1000.  Hirsch 
gives  the  ratio  for  Italy  as  2.4  to  1000.  The  statement  of 
Pelmann,  who  has  given  much  attention  to  the  subject,  is 
generally  accepted,  that  1.5  to  1000  inhabitants  does  not 
exceed  the  actual  number. 

Applying  this  ratio  to  the  following  States  and  countries, 
and  taking  the  population  as  given  by  the  last  census  or 
estimating  it  to  the  present  time,  there  are  of  epileptics  in 
Germany,  including  Prussia,  about  74,000,  in  France  57,500, 
in  Switzerland  4400,  in  Italy  46,000,  in  European  Russia 
138,000,  in  England  46,000,  in  Scotland  6000,  in  Ireland 
7000,  in  the  United  States  113,000.  It  is  not  to  be  inferred 
that  all  of  these  large  numbers  of  epileptics  should  be  placed 
in  asylums.  What  percentage  of  them  require  institutional 
care  for  their  own  welfare  or  that  of  society  we  have  no 
statistics  to  determine. 

Lack  of  Provision  for  Epileptics  in  the  United  States. — In 
none  of  the  forty-five  States  of  the  Union,  excepting  Ohio, 
New  York,  Massachusetts,  New  Jersey,  and  Texas,  is  there 
a  State  institution  exclusively  for  the  care  of  epileptics. 
The  United  States  Government  has  provided  no  separate 


1 6  CARE   AND  TREATMENT  OF  EPILEPTICS. 

institution  for  sane  epileptics.  Insane  epileptics  are  pro- 
vided for  in  the  Government  Hospital  for  the  Insane  in 
the  District  of  Columbia  in  buildings  constructed  for  their 
care. 

Wherever  there  are  institutions  for  the  feeble-minded 
there  are  usually  more  or  less  of  the  epileptic  class  among 
the  inmates.  Dr.  Powell  gives  the  number  of  epileptics  in 
institutions  for  the  feeble-minded  in  the  United  States  as 
about  1 200.  In  some  institutions  of  this  class  he  has  found 
upwards  of  30  per  cent,  of  epileptics.  In  the  Iowa  institu- 
tion there  are  178  among  the  690  inmates.  There  are  a  few 
epileptics  in  the  New  York  State  Institution  for  Feeble- 
Minded  Children,  at  Syracuse,  but  they  were  admitted 
under  exceptional  circumstances  or  became  epileptic  after 
admission.  It  is  contrary  to  the  rules  of  the  institution  to 
receive  them.  The  same  may  be  said  of  the  Massachusetts 
School  for  Feeble-Minded,  at  Waltham,  in  which,  at  the 
date  of  January,  1898,  there  were  seventy-one  epileptic 
children.  All  institutions  for  the  feeble-minded  in  the 
United  States  having  buildings  constituting  a  distinct  de- 
partment for  epileptics  are  mentioned  in  this  work. 

It  is  coming  to  be  recognized,  if  it  has  not  already  been 
conceded,  that  institutions  for  the  feeble-minded  do  not 
meet  the  requirements  for  epileptics.  Experience  in  in- 
stitutions of  this  kind  has  demonstrated  the  desirability  of 
having  separate  wards  for  epileptic  children  and  the  advan- 
tages resulting  therefrom  both  to  the  epileptic  and  the 
feeble-minded.  From  separate  wards  a  development  to- 
wards separate  buildings  has  been  natural,  as  seen  in  Cali- 
fornia, Minnesota,  and  elsewhere.  Further  development 
along  the  same  lines  may  lead  eventually  to  the  establish- 
ment of  entirely  distinct  institutions  for  epileptic  children. 
Children,  in  any  event,  must  be  separated  from  adults,  the 


CONDITION  OF   THE  EPILEPTIC.  1 7 

former  being  an  especially  hopeful  class  and  susceptible  of 
great  improvement.  A  better  medical  system  is  obtained 
for  epileptic  children  by  separating  them  from  the  feeble- 
minded. They  also  require  a  different  diet  and  different 
educational  methods.  Moreover,  an  intelligent  epileptic 
child  is  sensitive  about  being  classed  with  the  non-epileptic 
congenital  idiot.  The  highest  mental  and  physical  improve- 
ment of  the  child  should  be  kept  constantly  in  view. 

In  all  the  States  where  institutions  for  epileptics  have 
been  established  there  has  been  immediately  an  overwhelm- 
ing pressure  for  admission,  some  of  the  appeals  coming 
from  friends,  and  some,  more  pitiful,  from  the  sufferers 
themselves. 

Relation  of  the  Epileptic  to  Society. — The  epileptic  holds 
an  anomalous  position  in  society.  As  a  child  he  is  an  ob- 
ject of  solicitude  to  his  parents  or  guardians.  The  street  to 
him  is  full  of  danger,  and  if  sent  to  school  he  is  liable 
to  seizures  on  the  way  or  in  the  class-room.  At  school  his 
attacks  shock  his  classmates  and  create  confusion.  He 
cannot  attend  church  and  public  entertainments,  nor  partici- 
pate in  social  gatherings  with  those  of  his  own  age  and 
station.  In  consequence  of  his  infirmity,  the  epileptic 
grows  up  in  idleness  and  ignorance,  bereft  of  companion- 
ship outside  of  the  family,  and,  friendless,  he  silently  broods 
over  his  isolated  and  helpless  condition. 

If  the  epileptic  succeeds  in  learning  a  trade,  business  men 
are  reluctant  to  employ  him,  and  artisans  will  not  work  with 
him,  especially  if  sharp-edged  tools  are  used.  I  shall  never 
forget  the  shock  experienced,  when  I  was  a  lad,  in  seeing  a 
journeyman  workman,  a  tall,  manly,  but  sad-faced  young 
man,  fall  at  his  bench  with  keen-edged  tools  within  his 
reach,  his  dazed  fellow-workmen  moving  in  awe  about  him 
as  he  struggled  in  convulsions,  with  open  eyes,  set  teeth, 


1 8  CARE  AND  TREATMENT  OF  EPILEPTICS. 

and  foaming  mouth.  He  was  an  ambitious  young  man,  of 
good  character,  and  a  skilful  workman ;  but  he  was  obliged 
to  leave  his  position  on  account  of  his  infirmity  and  seek  a 
new  situation,  where,  undoubtedly,  he  had  to  go  through 
the  same  experience.  In  such  cases  there  is  but  one  result, 
— the  breaking  down  of  all  hope  and  energy. 

The  epileptic  workman  having  a  trade,  but  unable  to  find 
employment,  gradually  sinks  into  a  condition  of  public  de- 
pendence. Frequently  he  is  sent  to  the  poorhouse,  where 
he  is  brought  into  close  association  with  a  mixed  and  un- 
sympathetic population,  and  where  there  is  no  special  pro- 
vision for  his  care  or  proper  medical  treatment.  Here  he  is 
regarded  with  aversion  and  distrust,  and  is  a  cause  of 
unhappiness,  and  sometimes  of  danger,  to  others.  Not 
infrequently  the  wrong  is  committed  of  sending  him  to  an 
insane  asylum.  The  late  Dr.  Richard  Gundry,  speaking  of 
epileptics  in  insane  asylums,  said:  "  However  mild  their 
forms  of  insanity  generally,  they  are  liable  to  explosive 
paroxysms  of  fury ;  and  their  epileptic  attacks  are  shocking 
to  witness.  There  can  be  no  question  that  their  frequent  fits 
exercise  a  very  unfavorable  influence  upon  other  patients 
of  an  impressionable  nature.  For  this  reason,  doubtless, 
many  who  should  be  under  hospital  care  are  refused  admit- 
tance, and  drift  into  various  nooks  and  corners,  where  God 
alone  knows  how  they  subsist." 

The  apprehension  of  what  an  epileptic  may  do,  and  the 
seeming  necessity  for  his  seclusion  in  order  to  protect  the 
community,  cause  him  in  some  of  the  American  States, 
for  lack  of  other  provision  or  for  greater  convenience  or 
security,  to  be  confined  in  jail,  thus  adding  to  his  misfor- 
tune the  brand  of  criminality. 

The  adult  female  epileptic  is  not  only  liable  to  all  the 
dangers  and  sufferings  of  the  opposite  sex,  but,  through  her 


CONDITION  OF   THE  EPILEPTIC.  1 9 

helplessness,  is  exposed  to  the  immodest  gaze  and  licentious 
advances  of  the  unprincipled. 

For  lack  of  suitable  provision  for  epileptic  children,  many 
of  them,  bright  and  intelligent,  find  their  way  in  some 
States  into  public  care  in  forced  companionship  with  the 
lowest  class  of  idiots. 

In  the  family  home  constant  watchfulness  must  be  exer- 
cised over  the  epileptic,  and  a  wage-earner  is  frequently 
withdrawn  from  remunerative  labor  to  attend  him,  with 
the  consequence  of  a  double  pecuniary  burden  upon  the 
family.  The  struggle  of  many  a  worthy  family  to  bear 
such  a  burden  and  yet  maintain  themselves  in  respectability 
is  pitiful  to  witness.  Only  a  few  days  previous  to  penning 
this  paragraph  it  came  to  my  knowledge  that  a  poor  widow 
in  the  neighborhood  of  my  home,  burdened  with  the  care 
of  an  epileptic  child  who  required  every  whim  to  be  grati- 
fied, committed  suicide  by  drowning  herself.  She  had 
found  life  intolerable.  Every  one  familiar  with  the  condi- 
tion of  a  poverty-stricken  family  in  which  there  is  an  epilep- 
tic member,  and  witnessing  the  settled  gloom  over  a 
household  where  perhaps  the  mother  is  obliged  to  work  out 
for  hire  while  her  heart  is  heavy  with  the  dread  of  some 
horrible  accident  happening  to  her  child  at  home,  will  be 
impressed  with  the  change  from  despondency  to  cheerful- 
ness after  the  epileptic  has  been  removed  to  a  colony  where 
all  the  possibilities  of  enjoyment  and  improvement  and  use- 
fulness that  remain  in  his  life  are  within  his  reach,  and  will 
eagerly  desire  that  like  changes  might  be  made  in  number- 
less similar  households  throughout  the  land. 

It  has  been  forcibly  said  by  one  entirely  familiar  with  his 
subject:  "Throughout  the  whole  range  of  human  mis- 
fortune we  know  of  nothing  that  can  equal  in  its  abject 
wretchedness  the  lot  of  the  neglected  and  confirmed  epilep- 


20  CARE  AND  TREATMENT  OF  EPILEPTICS. 

tic,  whose  intellectual  light  is  being  continually  diminished 
by  the  terror-full  seizures,  and  whose  physical  existence  is 
being  steadily  sapped  and  blighted  by  this  curse  of  our  age. 
The  insidious  character  of  its  inception,  the  multitudinous 
causes  from  which  it  may  have  its  origin,  the  subtle  charac- 
ter of  its  progress,  the  thousand  deceiving  phases  of  its 
treatment,  and  the  horrible  consequences  of  its  unchecked 
ravages,  all  combine  to  make  epilepsy  a  disease  condition 
of  unusual  importance." 

Reasons  for  Special  Provision. — The  reasons  for  separate 
provision  for  epileptics  are  so  obvious  as  seemingly  not  to 
require  any  argument  to  sustain  them.  They  have  been 
forcibly  set  forth  by  numerous  writers  and  speakers  regarded 
as  authorities  upon  this  subject.  Dr.  Rutter,  Dr.  Spratling, 
Dr.  Peterson,  Dr.  Bullard,  Dr.  Sinkler,  Dr.  Drewry,  Dr. 
Wildermuth,  Dr.  Kolle,  Pastor  von  Bodelschwingh,  and 
many  others  whose  opinions  may  not  be  disregarded,  have 
borne  emphatic  testimony  to  the  necessity  of  providing 
homelike  institutional  care,  with  expert  medical  treatment, 
for  this  numerous  and  neglected  class.  These  opinions 
have  been  so  clearly  and  forcibly  urged  that  we  must  accept 
them ;  and  this  provision  should  be  made,  not  doubtfully, 
hesitatingly,  and  parsimoniously,  but  promptly  and  gener- 
ously, in  full  recognition  of  the  claims  of  a  universal  human 
brotherhood. 

It  has  been  thought  by  some  that,  in  bringing  together 
in  one  institution  a  great  number  suffering  from  this  infirm- 
ity, their  unhappy  symptoms  would  be  reflected  upon  one 
another,  to  the  disadvantage  of  all.  On  the  contrary,  ex- 
perience has  shown  that,  so  far  from  association  being  harm- 
ful, it  awakens  sympathy  one  for  another.  Moreover,  in 
the  colony,  the  epileptic  finds  himself  again  a  part  of  the 
world's  machinery,   from  which  he  had  dropped  out,  and 


SPECIAL   PROVISION.  21 

hopeful  aspirations  take  the  place  of  despondency  and 
gloom. 

Special  institutions  or  colonies,  besides  benefiting  the  un- 
fortunate sufferers,  may  be  made  to  serve  the  economy  of 
the  State.  Under  an  advanced  system  of  treatment,  many 
epileptics,  while  rendering  some  return  by  their  labor  for 
the  benefits  they  receive,  may  be,  if  not  entirely  cured,  so 
far  restored  to  health  as  to  be  able  to  earn  a  support  after 
leaving  the  colony,  and  thus  become  productive  members 
of  a  community  instead  of  a  burden  upon  it. 

In  the  establishment  of  colonies  for  epileptics  classification 
of  the  dependent  classes  is  extended,  and  institutions  organ- 
ized for  other  purposes  and  not  adapted  to  the  care  of 
epileptics  are  relieved  of  an  incongruous  element.  Dr. 
John  Morris,  of  Maryland,  says:  "  One  half  of  the  appli- 
cants for  admission  to  the  Home  for  the  Feeble-Minded  in 
Maryland  are  victims  of  epilepsy.  These  unfortunates 
cannot  be  admitted  to  the  institution  for  the  reason  that 
they  are  a  disturbing  element,  and  would  exercise  an  in- 
jurious influence  on  the  inmates,  and  thus  retard  their 
recovery.  To  treat  epileptics,  you  must  have  an  institution 
solely  devoted  to  their  care.  The  younger  epileptics  par- 
ticularly require  separate  conditions  and  treatment." 

In  colonizing  epileptics  society  is  relieved  in  some  measure 
of  a  dangerous  element  and  the  public  safety  promoted, 
while  the  procreation  of  degenerate  offspring  is  brought 
under  restrictions.  Dr.  Powell  says:  "  Of  all  hereditary 
factors,  except  feeble-mindedness,  none  are  so  prolific  in 
entailing  a  blight  upon  succeeding  generations  as  epilepsy. 
I  earnestly  coincide  with  the  opinion  of  those  who  are  seek- 
ing to  establish  separate  institutions  or  colonies  for  them, 
feeling  that  this  mild  imprisonment  would  prove  a  humane 
and  effectual  means  of  cutting  off  another  source  of  the  pro- 


22  CARE  AND  TREATMENT  OF  EPILEPTICS. 

duction  of,  not  only  feeble-mindedness,  but  other  forms  of 
mental  and  physical  degeneracy." 

Dispensary  treatment  of  epileptics  in  cities,  while  it 
ameliorates  their  condition,  falls  short  of  meeting  their 
requirements.  Dr.  John  L.  Hildreth,  of  Massachusetts, 
gives  the  following  testimony  on  this  point:  "  I  became 
much  interested  several  years  ago  in  the  subject  of  epilepsy, 
largely  because  I  found  dispensary  treatment  of  such  cases 
very  unsatisfactory.  .  .  .  Some  member  of  the  family 
would  bring  the  patient  to  the  dispensary,  and  describe  the 
troubles  that  had  been  going  on  some  time.  He  would 
be  told  the  treatment  must  be  long  continued,  perhaps  some 
two  or  three  years  after  the  patient  seems  well.  The  poor 
get  much  discouraged  at  such  a  statement.  They  drift 
about  a  good  deal.  Whether  they  go  to  the  physician  at 
the  hospital  or  to  the  general  practitioner,  they  neglect  the 
treatment,  do  not  look  after  the  diet  or  exercise,  do  not  see 
that  the  patient  is  properly  taken  care  of,  do  not  report  as 
they  should ;  and  it  is  hard  to  get  these  people  to  continue 
to  bring  patients  to  the  hospital  or  the  dispensary  for  treat- 
ment. They  do  not  see  great  results  at  first,  and  cannot  be 
made  to  continue.  These  patients  should  be  taken  in  the 
beginning  and  put  under  special  treatment,  where  diet 
could  be  regulated,  and  habits  looked  after,  and  medicine 
given  regularly." 

The  peculiar  nature  of  the  disease  makes  its  treatment  by 
skilled  experts  a  necessity  ;  and  in  a  colony  better  treatment 
can  be  given  epileptics  than  by  physicians  in  private  prac- 
tice. Dr.  Sanger  Brown,  of  Illinois,  says:  "  I  think  most 
of  us  in  practice  have  been  struck  at  times  with  our  help- 
lessness in  our  attempts  to  relieve  these  people  from  a  moral 
standpoint,  and  we  are  unable  physically  to  offer  a  practical 
suggestion  for  the  guidance  of  these  poor  unfortunate  suf- 


SPECIAL  PROVISION.  2$ 

ferers.  We  can  generally  lay  out  work  for  them,  such  as 
occupational  treatment,  but  in  this  particular  disease,  where 
occupation  is  needed  more  than  in  any  other  perhaps,  we  are 
perfectly  helpless.  We  know  that  we  cannot  honestly  and 
safely  use  any  influence  to  get  such  people  into  positions  of 
trust.  Some  of  these  persons  are  often  men  of  remarkable 
mental  ability,  yet  our  hands  are  tied.  One  of  the  crying 
necessities  of  the  age  is  that  this  particular  class  of  people 
should  be  practically  dealt  with." 

There  is  a  decided  gain  to  science  in  the  opportunity 
afforded  to  study  the  disease  under  the  most  favorable  cir- 
cumstances, with  a  view  to  ascertaining  its  causes  and  the 
means  of  cure.  Dr.  A.  E.  Osborne,  of  California,  in  making 
an  appeal  to  the  Legislature  of  his  State  in  1887  in  behalf 
of  institutional  provision  for  epileptics,  made  use  of  the  fol- 
lowing forcible  language:  "  That  a  very  large  percentage 
of  epileptic  cases  can  be  checked,  and  many  permanently 
cured,  I  have  no  doubt,  provided  the  proper  means  be 
secured  for  their  rational  treatment.     .     .     . 

'  Through  my  office  window,  as  I  write,  I  can  rest  my 
eye  upon  the  glistening  dome  of  that  noble  structure,  dedi- 
cated to  science,  which  rests  in  quiet  splendor  like  a  mighty 
gem  upon  the  brow  of  grand  Mount  Hamilton.  Within  it 
is  poised  that  unique  and  matchless  instrument  whose 
mighty  sweep  is  designed  to  pierce  the  very  depths  of  the 
heavens  and  bring  to  the  scientist's  eye  heretofore  unrevealed 
records.  But  hark!  Upon  my  ear  there  breaks  the  de- 
spairing shriek  of  an  epileptic  girl,  who,  frantic  from  the 
terrors  of  the  aura,  rushes  towards  her  playmate  to  seize 
her,  but  reels  and  falls,  with  clenched  fists  and  foaming  lips, 
prostrate  to  the  ground.  And  I  feel  as  though  that  despair- 
ing shriek  should  be  heard  around  and  through  the  entire 
extent  of  the  State,  until  a  similar  munificence  to  that  of 


24  CARE  AND  TREATMENT  OF  EPILEPTICS. 

Lick  should  build  another  temple  to  science,  but  dedicated 
to  the  study  of  the  poor  epileptic ;  and  within  whose  walls 
there  should  be  found  somewhere  in  its  armamentarium  the 
means  of  exploring  the  hidden  secrets  of  the  mind  and  brain, 
that  at  last  man  might  ravel  out  the  tangled  thread  of  the 
disease  and  become  master  of  the  secret,  even  to  the 
cure." 

Dr.  Jules  Morel,  of  Belgium,  thus  presents  the  duty  of 
the  State  to  this  class:  "It  is  necessary  to  consider  that 
epileptics,  for  the  most  part,  are  born  of  parents  who  trans- 
mit an  hereditary  taint  to  their  offspring,  and  that  later  on 
they  tend  to  degeneracy  under  the  influence  of  other  causes, 
especially  alcoholism.  The  parents  of  epileptic  children, 
for  lack  of  facilities  or  for  other  cause,  may  be  considered 
as  incapable  of  caring  for  their  education  and  training,  and 
it  becomes  the  duty  of  the  State  to  take  the  children  from 
them  and  properly  care  for  them.  This  is  the  duty  of  the 
State,  both  for  the  sake  of  humanity  and  for  reasons  of 
economy.  The  epileptic  uncared  for  is  exposed  to  all  sorts 
of  excesses.  As  he  grows  older  he  is  likely  to  give  way  to 
habits  of  intemperance,  to  immorality,  to  violent  acts;  or, 
as  is  not  infrequently  the  case,  to  all  of  these  at  once.  The 
State  must  protect  its  citizens  by  removing  the  sickly  and 
injurious  elements  from  society  and  providing  for  them  in 
the  interest  of  the  public  and  of  those  requiring  protection." 

Preliminary  Action  in  Founding  Colonies. — In  establishing 
colonies  for  epileptics  under  State  auspices  in  States  where 
none  exist,  the  first  step  should  be  to  collect  such  statistics 
and  information  as  are  obtainable  and  bring  them  to  the 
attention  of  the  Legislature.  There  must  be  at  the  outset 
some  basis  for  legislative  action.  The  subject  coming  under 
the  special  jurisdiction  of  State  boards  of  charities,  the  de- 
sired information  can  best  be  obtained  by  such  boards,  they 


PRIVATE  BENEVOLENCE.  2$ 

having  the  necessary  facilities  for  obtaining  it.  With  such 
facts  and  estimates  of  outlay  for  an  institution  presented  to 
the  Legislature  and  supported  by  a  resolution  of  the  State 
Medical  Society  or  other  medical  organization,  and  by 
leading  specialists  in  mental  diseases,  Legislatures  may  be 
induced  to  create  a  special  commission  for  selecting  a  site 
and  for  taking  preliminary  steps  for  the  permanent  estab- 
lishment of  a  colony.  In  States  having  no  charity  boards, 
the  initiative  must  be  taken  by  the  State  Medical  and  other 
societies,  by  influencing  the  Legislature  to  create  a  com- 
mission to  gather  facts  and  information  relating  to  the 
subject  and  to  report  thereon.  Following  this  report,  the 
friends  of  the  epileptic  should  endeavor  to  secure  legisla- 
tion creating  a  commission  to  select  a  site.  If  the  first 
effort  fails,  it  should  be  repeated  again  and  again.  This 
course,  it  is  believed,  if  persistently  and  prudently  followed, 
will  result  in  the  attainment  of  the  desired  object,  although 
years  may  elapse  before  success  is  achieved. 

Co-operation  with  Private  Be?ievolence. — It  is  to  be  re- 
gretted that  the  State  does  not  avail  itself  of  the  services  of 
private  charitable  organizations  in  a  greater  degree  than  it 
does  in  caring  for  epileptics.  To  the  extent  that  the  work 
is  undertaken  by  benevolent  agencies  the  public  is  relieved 
of  the  expense  of  erecting  buildings,  and  in  some  measure 
of  the  cost  of  maintenance.  If  duly  incorporated  private 
charities,  subject  to  strict  State  supervision,  were  encour- 
aged in  this  work  by  the  payment  of  a  liberal  weekly  per 
capita  allowance,  which  need  not,  however,  be  equal  to  the 
full  cost  of  support,  much  of  the  work  could  be  done  in 
this  way  and  placed  under  the  direction  of  those  engaging 
in  it  out  of  pure  benevolence.  It  is  believed  that,  to  the 
extent  that  private  benevolence  is  interested,  the  work  will 
be  conducted  on  a  higher  plane  of   disinterestedness  and 


26  CARE  AND  TREATMENT  OF  EPILEPTICS. 

society  will  be  benefited  by  stimulating  charitable  zeal. 
Private  benevolent  agencies  cannot,  however,  be  relied 
upon  to  do  the  entire  work,  because  of  its  vastness.  It 
should  be  regarded  as  the  imperative  duty  of  the  State  to 
create  provision  itself  or  to  secure  it  in  institutions  already 
established  in  its  own  or  adjoining  States.  In  every  State 
it  may  not  be  practicable  to  establish  epileptic  colonies,  but 
there  is  no  reason  why  it  should  not  be  made  mandatory 
by  every  State,  as  it  is  in  Prussia,  to  provide  in  some  way 
proper  asylum  care  for  its  epileptics. 

Selecting  a  Site. — In  looking  for  a  site,  it  should  be  an- 
nounced that  gifts  of  land  will  not  be  considered ;  that  the 
State  is  not  a  suppliant  for  the  bounty  of  this  or  that 
locality  specially  favored  by  a  financial  backing  or  by 
political  influence ;  that  it  wishes  to  pay  for  value  received ; 
and  that,  in  the  interests  of  the  entire  State,  it  is  intended 
to  select  the  best  site  in  the  State.  When  this  plan  has  not 
been  adhered  to  and  the  State  has  accepted  gifts  of  sites, 
numerous  embarrassments,  pecuniary  and  otherwise,  have 
subsequently  arisen,  to  the  disadvantage  of  the  State. 

Among  primary  considerations  are  those  of  healthfulness, 
especially  freedom  from  malarial  influences,  a  bountiful 
water-supply,  and  facilities  for  disposing  of  sewage.  The 
water  should  be  subjected  to  a  chemical  analysis.  The 
centre  of  epileptic  population  should  be  considered,  al- 
though this  is  a  matter  of  minor  importance  as  compared 
with  some  other  considerations.  A  situation  in  close  prox- 
imity to  a  town  or  large  village  is  objectionable.  At  the 
same  time  it  should  not  be  so  remote  as  to  preclude  those 
connected  with  the  institution  from  the  enjoyments  of 
social  life  and  the  intellectual  culture  a  town  affords. 

The  question  of  climate  should  not  be  overlooked.  In 
the  same  State  there  may  be  a  month's  difference  in  the 


FOUNDING   COLONIES.  2J 

length  of  the  mild  season,  permitting  much  more  outdoor 
life  and  outdoor  employment  in  some  sections,  which  counts 
a  good  deal  on  the  score  of  health,  and  is  a  matter  of  econ- 
omy in  the  employment  of  labor,  in  the  maintenance  of 
farm  stock  during  the  winter,  and  in  the  consumption  of 
fuel. 

It  is  of  the  utmost  importance  to  secure  a  liberal  acreage 
of  land.  In  founding  similar  institutions  the  State  has 
sometimes  been  put  to  a  great  disadvantage,  and  later  has 
found  it  impracticable  to  obtain  at  any  price  a  sufficient 
quantity  of  land,  which  it  could  readily  have  secured  at  the 
outset  at  a  moderate  cost.  After  the  State  has  begun  to 
make  improvements  a  speculative  value  affects  surrounding 
property.  No  hard-and-fast  rule  can  be  laid  down  for  the 
amount  of  land  required  for  an  epileptic  colony,  which 
should  be  largely  agricultural ;  but  for  the  smallest  enter- 
prise of  this  kind  it  is  advisable  to  have  at  least  five  hundred 
acres.  If  it  is  thought  that  the  institution  will  eventually 
provide  for  one  thousand  inmates,  from  fifteen  hundred  to 
two  thousand  acres  will  not  be  found  too  much.  An  in- 
stance is  not  on  record  of  a  State  having  suffered  loss  by 
making  a  large  investment  in  land  in  purchasing  a  site  for  a 
State  institution.  A  large  acreage  of  land  is  desirable,  not 
only  for  the  opportunity  afforded  for  giving  patients  out- 
door work,  but  in  order  to  reduce  the  cost  of  maintenance 
by  producing  supplies,  including  meat,  milk,  and  eggs,  as 
well  as  vegetables.  However  large  the  estate,  any  seeming 
surplus  of  land  can  be  used  for  pasturage  and  fattening 
stock. 

Particular  attention  should  be  given  to  the  character  of 
the  soil,  which  should  be  productive,  easily  cultivated,  and 
a  goodly  portion  of  it  specially  adapted  to  gardening  and 
fruit-growing.     Warm,  loamy  earth  is  pleasant  to  cultivate, 


28  CARE  AND  TREATMENT  OF  EPILEPTICS. 

but  the  tillage  of  stiff,  lumpy  clay,  or  stony  land,  is  regarded 
with  dislike  by  the  farmer  or  gardener.  A  tract  of  land 
gently  rolling,  with  a  general  inclination  to  the  east  and 
south,  is  better  than  a  bleak  northern  exposure. 

Convenient  proximity  to  a  railway  station  is  desirable, 
but  it  is  not  well  to  have  a  railway  line  pass  through  the 
grounds.  It  is  better  to  be  within  a  reasonable  distance  of 
a  passenger  station  and  provide  means  for  obtaining  heavy 
supplies  by  constructing  a  switch  to  the  main  track.  Ac- 
cidents and  loss  of  life  sometimes  occur  from  patients  falling 
upon  the  railway  track  while  in  a  fit. 

Organization. — In  organizing  boards  of  management  it  is 
thought  that  the  various  sections  of  the  State  or  of  the  dis- 
trict for  which  the  institution  provides  should  be  repre- 
sented. This  is  only  fair  to  the  citizens  of  all  sections  and 
is  but  just  to  the  epileptics  residing  in  different  sections. 
This  implies  a  greater  sacrifice  of  time  on  the  part  of  the 
managers,  but  there  are  always  capable  persons  to  be  found 
who  will  assume  the  responsibility,  and  often  the  greater  the 
sacrifice  to  be  made  the  more  earnest  and  disinterested  are 
those  who  take  the  office.  When  managers,  or  a  majority 
of  them,  are  appointed  from  the  locality  in  which  the  in- 
stitution is  situated,  questions  involving  local  interests  come 
up  which  are  at  variance  with  the  interests  of  the  taxpayers 
of  the  whole  State,  and  cause  embarrassment.  It  is  as- 
sumed that,  in  the  management  of  the  colony,  the  super- 
intendent is  vested  with  large  executive  power;  that  he 
is,  in  fact,  the  executive  officer  of  the  board  for  all  prac- 
tical purposes.  Under  such  circumstances  it  will  be  found 
best  to  instruct  this  officer  to  carry  out  the  wishes  of  the 
board  rather  than  delegate  the  power  to  special  or  standing 
committees. 

The  utmost  care  should  be  taken  to  secure  a  competent 


ORGANIZA  TION.  29 

superintendent.  Having  done  this,  and  the  general  and 
particular  policy  having  been  defined,  and  the  rules  and 
regulations  of  the  board  having  been  laid  down,  it  is  but 
just  to  leave  the  superintendent  free  to  carry  them  out.  If 
he  will  not  or  cannot  do  so  on  account  of  incapacity  or  for 
other  cause,  then  a  new  superintendent  should  be  appointed. 
When  this  course  is  pursued  there  is  not  the  same  necessity 
for  the  members  of  a  board  of  managers  to  reside  in  close 
proximity  to  the  colony.  At  first  thought  it  would  seem 
that  the  best  results  would  come  from  the  appointment  of 
a  board  all  the  members  of  which  reside  in  near  proximity 
to  the  institution,  but  experience  does  not  warrant  this  con- 
clusion. On  the  contrary,  serious  difficulties  are  known  to 
have  arisen  in  this  way,  and  the  interests  of  the  State  have 
suffered  in  consequence. 

On  every  board  of  managers  of  a  State  or  private  institu- 
tion for  epileptics  women  should  be  represented.  The 
reasons  for  such  representation  are  obvious.  Numerous 
unhappy  instances  are  on  record  where  female  delicacy  on 
the  part  of  teachers,  nurses,  attendants,  and  servants  in 
charitable  institutions  has  stood  in  the  way  of  facts  being 
revealed  to  men  responsible  for  the  management  of  the  in- 
stitution, which  it  was  necessary  they  should  know  for  the 
protection  and  welfare  of  the  inmates.  The  superior  knowl- 
edge possessed  by  women  in  matters  pertaining  to  good 
housekeeping,  comfortable  personal  care, domestic  economy, 
and  the  peculiar  wants  of  their  sex,  should  be  availed  of  to 
perfect  the  administration  and  lighten  the  pecuniary  burden 
of  the  State.  In  the  care  of  children  and  young  persons,  to 
deprive  them  of  counsel  based  on  a  mother's  experience,  and 
devotion  which  comes  from  a  motherly  instinct,  is  unjustifi- 
able. To  deprive  women  suffering  from  bodily  or  mental 
disease  from  the  benefits  resulting  from  the  representation 


30  CARE  AND  TREATMENT  OF  EPILEPTICS. 

of  their  sex  on  the  board  of  management,  is  an  unwarranted 
assumption  of  masculine  power. 

Some  of  the  reasons  favoring  the  representation  of 
women  on  boards  of  management  apply  with  equal  force  to 
the  appointment  of  a  woman  physician  on  the  medical  staff 
of  an  institution  where  there  are  women  or  children.  All 
women,  however,  do  not  want  a  female  physician  to  serve 
them,  and  they  should  not  be  restricted  to  such;  but  it 
would  seem  self-evident  that  a  properly  qualified  female 
physician  on  the  medical  staff  of  an  institution  for  epileptics 
is  indispensable. 

Opening  a  Colony. — It  has  been  found  disadvantageous  to 
open  a  colony  for  epileptics  with  a  large  number  of  patients. 
It  is  better  to  receive  a  few  at  first  and  increase  the  number 
gradually.  In  this  way  the  patients  are  more  easily  ad- 
justed and  reconciled  to  their  new  life,  and  much  friction  is 
avoided.  This  course,  it  must  be  conceded,  increases  for 
the  first  year  or  two  the  per  capita  cost,  but  the  advantage 
resulting  is  more  than  compensatory.  Neither  is  it  well  to 
admit  patients  promiscuously.  It  is  better  to  discriminate 
between  those  whom  there  is  a  reasonable  prospect  of  cur- 
ing or  improving  and  those  who  have  already  sunk  to  a  low 
condition.  It  is  best  to  select  first  the  most  hopeful  cases 
from  the  poorhouses  and  those  supported  by  outdoor  relief. 

Improvement  of  Grounds. — After  a  site  has  been  purchased 
time  should  be  taken  by  the  board  of  managers,  aided  by 
competent  experts,  to  make  a  careful  examination  of  the 
property,  and  a  plan  should  be  perfected  before  any  im- 
provements are  begun.  Deliberation  at  the  outset  may  save 
disappointment  and  embarrassment  afterwards.  In  select- 
ing sites  for  the  buildings  the  elevation  and  grade  of  the 
land  should  be  considered,  in  order  to  secure  situations  in 
harmony  with  the  natural  outline  of  the  landscape,   and 


IMPRO  VEMENTS.  3  I 

avoid  unnecessary  and  expensive  grading  and  terracing. 
Many  a  fine  site  for  a  building  has  been  spoiled  in  the  at- 
tempt to  improve  by  grading  what  nature  had  left  in  grace- 
ful outline  and  easy  inclination.  The  beauties  of  the 
immediate  and  surrounding  landscape  should  be  kept  in 
mind,  and  the  property  should  be  developed  so  as  to  afford 
the  greatest  possible  enjoyment  to  the  inmates  of  the  in- 
stitution from  the  contemplation  of  the  attractions  of  nature. 
Developments  on  this  line  need  not  interfere  with  practical 
and  economical  aims.  The  preservation  of  whatever  of 
natural  beauty  there  is  about  the  estate  should  be  a  primary 
consideration,  as  its  development,  especially  in  the  growth 
of  trees,  is  a  work  of  years.  One  familiar  with  the  delight- 
ful surroundings  of  some  of  the  English  institutions,  as  also 
many  of  the  judiciously  improved  country  places  both  in 
England  and  America,  can  realize  the  happy  effect  that 
may  be  attained  by  the  application  of  artistic  rules  in  im- 
proving a  large  landed  property.  One  of  these  cannot  be 
too  strongly  emphasized, — "  Remove  objects  near  to  you 
while  there  remains  something  more  pleasing  beyond,  and 
plant  to  hide  that  which  is  offensive  to  the  eye,  either  in  a 
near  or  distant  prospect."  Fences  showing  limitations  of 
space  should  be  dispensed  with  or  kept  out  of  sight  as  much 
as  possible  by  judicious  planting  of  shrubbery,  and,  when 
practicable,  by  taking  advantage  of  depressions  in  the 
grades  of  the  land. 

In  planting  and  improving  grounds,  a  view  into  a  park  or 
a  glimpse  of  a  pleasing  prospect  should  not  be  obstructed. 
The  arrangement  of  the  buildings  should  be  such  as  to  com- 
mand these  outlooks.  Should  the  property  include  a  sheet 
of  water,  even  though  small,  it  may  be  made  an  attractive 
feature  of  a  park;  and,  with  patriarchal  trees  around  its 
border,  it  may  be  a  source  of  never-failing  pleasure.    Under 


32  CARE  AND  TREATMENT  OF  EPILEPTICS. 

any  plan,  cottages  should  always  have  as  pleasing  and  as 
extended  a  view  as  practicable.  The  outlook  from  a  sit- 
ting-room of  a  dwelling  should  never  be  against  the  walls 
of  another  building. 

An  extended  expanse  of  green  lawn  with  shade  from  large 
trees  is  preferable  to  numerous  flower-beds  requiring  much 
culture  and  attention.  Ornamental  shrubs  at  curves  in  the 
roads  and  walks  may  be  disposed  so  as  not  to  interfere  with 
landscape  views,  and  at  the  same  time  serve  as  reasons  for 
making  a  graceful  curve.  To  make  a  bend  in  a  road  or 
walk  without  any  apparent  purpose  is  highly  artificial. 

In  building  up  a  colony  the  opportunity  is  presented  for 
making  improvements  on  aesthetic  lines  that  are  not  pos- 
sible in  a  village  community,  for  the  reason  that  a  high  ideal 
adopted  by  one  resident  is  neutralized  by  his  neighbor's 
lack  of  good  taste  and  utter  disregard  of  artistic  rules. 
On  the  other  hand,  the  development  of  the  broad  estate  of 
a  colony  may  proceed  under  one  direction  so  as  to  attain 
a  harmonious  whole,  affording  great  enjoyment  to  every 
beholder,  although  not  every  one  may  be  conscious  of  the 
reason  for  it.  In  almost  every  human  being  the  love  of  na- 
ture is  instinctive,  and  it  should  be  regarded  in  the  light  of 
an  obligation  to  afford  the  greatest  possible  happiness  from 
this  source  to  those  who  are  restricted  to  institutional  life. 

The  exercise  of  aesthetic  taste  as  thus  suggested  in  the 
grounds  devoted  to  ornamental  improvements  and  for  living 
purposes  need  not  interfere  with  plans  of  a  more  practical 
nature  for  the  agricultural  and  industrial  departments.  The 
gardens,  as  also  the  fields,  should  be  laid  out  so  as  to  be 
convenient  to  cultivate  and  for  gathering  the  crops.  The 
laying  out  of  serpentine  drives,  cutting  the  fields  and  gar- 
dens into  irregular-shaped  tracts,  awkward  to  plough  and 
cultivate,  should  not  be  permitted. 


CONS  TR  UC  TION.  3  3 

One  of  the  first  things  that  may  be  undertaken  to  advan- 
tage after  coming  into  possession  of  a  colony  estate  is  the 
planting  of  a  nursery  of  fruit,  shade,  and  ornamental  trees 
and  shrubbery.  By  means  of  a  home  nursery  a  profuse 
supply  of  these  articles  may  be  obtained  at  small  cost,  which 
will  have  attained  a  sufficient  growth  for  transplanting  by 
the  time  the  grounds  have  been  prepared  to  receive  them. 

Erection  of  Buildings. — While  the  buildings  of  a  colony 
should  not  be  absolutely  plain,  they  should  be  devoid  of 
those  architectural  features  which  are  purely  ornamental. 
Every  unnecessary  angle  or  gutter  in  a  roof  or  projection  is 
an  additional  item  to  be  kept  in  repair  as  time  and  the 
elements  do  their  work.  The  lines  of  a  building  may  be 
broken  so  as  to  produce  a  pleasing  effect  and  not  be  open 
to  the  objections  named.  The  ambition  of  the  architect  or 
the  enthusiasm  of  managers,  inspired  by  a  desire  to  have 
buildings  that  shall  be  a  pride  to  the  State  and  an  ornament 
to  the  locality,  has  often  led  to  expenditures  out  of  all  pro- 
portion to  the  object  in  view.  The  idea  has  become  too 
common  that  whatever  the  State  does  must  be  on  an  expen- 
sive scale  and  of  an  imposing  character.  The  development 
of  a  colony  should  be  on  practical  business  lines.  The  same 
principles  of  economy  that  govern  a  private  enterprise 
should  be  applied  here. 

Another  consideration  should  restrain  us  from  unnecessary 
expenditure  in  the  erection  of  buildings  for  the  afflicted 
classes.  The  numbers  comprising  them  are  so  large  and 
their  increase  so  rapid  that  the  means  never  seem  sufficient 
to  provide  the  necessary  accommodation  for  all  requiring 
it ;  and  a  wrong  is  committed  by  providing  palatial  accom- 
modations for  a  part  of  the  State's  beneficiaries  while 
others  are  left  in  absolute  neglect. 

Uniformity  in  buildings  should  also  be  avoided.     There 


34  CARE  AND  TREATMENT  OF  EPILEPTICS. 

is  no  necessity  that  even  two  of  them  should  be  alike.  By 
slight  changes  in  outline  they  may  be  made  to  appear  quite 
dissimilar,  and  less  like  adjuncts  to  a  great  manufacturing 
establishment.  In  cottage  residences  uniformity  is  particu- 
larly objectionable. 

In  the  arrangement  of  cottage  groups  of  dwellings  they 
may  be  placed  regularly  or  irregularly  according  to  the 
grade  of  the  land.  The  arrangement  of  the  cottages  for 
the  insane  at  the  Alt-Scherbitz  Asylum  in  Prussia  seems 
to  me  desirable.  The  cottages  for  male  patients  fill  about 
two  thirds  of  a  circle  facing  outward  upon  a  drive,  all  some- 
what elevated,  having  pleasant  outlooks  into  ornamental 
grounds.  The  industrial  buildings  are  in  the  rear  of  these. 
The  cottages  for  women  are  in  the  segment  of  a  circle,  ele- 
vated and  overlooking  the  river  Elster,  the  meadows  and 
plantations  beyond.  The  industrial  department  for  women, 
including  the  laundry,  is  situated  in  the  rear.  The  cooking 
is  done  in  a.  general  kitchen,  and  the  food  conveyed  to  the 
different  cottages  by  a  four-wheeled  vehicle,  so  constructed 
as  to  keep  the  food  warm  in  transit.  This  is  drawn  by 
horses.  In  each  cottage  are  heaters  for  keeping  the  food 
warm  while  being  served.  Each  cottage  has  a  dining-room, 
scullery,  and  cupboards  for  dishes.  In  some  institutions  on 
the  cottage  plan  there  are  a  general  kitchen  and  a  dining- 
room  or  a  dining-room  for  each  sex,  to  which  all  the  in- 
mates resort  for  their  meals.  In  some  cases  we  find  each 
cottage  forming  a  separate  establishment,  having  its  kitchen 
and  dining-room.  The  making  of  bread  and  the  launder- 
ing, however,  are  usually  done  in  separate  departments  for 
the  whole  colony.  In  some  other  institutions  the  cottages 
are  connected  by  light,  open  covered  ways,  protecting  the 
inmates  from  sun  and  rain  and  forming  at  all  seasons  a 
pleasant  promenade.       In   other  institutions  a  framework 


WOMEN'S    GROUP. 


\  N 


MEN'S    GROUP. 


METHOD    OF    GROUPING    COTTAGES    AND    INDUSTRIAL    BUILDINGS 
AT   ALT-SCHERBITZ    ASYLUM. 


CO  NS  TRUC  TION.  3  5 

is  supported  on  colonnades,  and  the  whole  work  is  covered 
with  vines.  This,  if  not  so  practical,  is  certainly  attractive 
and  picturesque. 

Covered  ways  between  buildings  are  often  regarded  as 
purely  ornamental  or  luxurious  appendages.  They  may  be 
justly  regarded,  however,  as  giving,  according  to  their 
breadth  and  length,  just  so  much  additional  space  to  a 
building.  Sheltered  from  the  rain,  dew,  and  hot  sun,  they 
afford  opportunities  for  the  patients  to  take  the  fresh  air 
while  promenading  or  sitting,  being  of  especial  advantage 
to  invalids,  and  relieve  the  space  within  the  buildings  with 
which  they  are  connected.  Moreover,  they  afford  a  means 
of  convenient  communication  between  the  buildings  at  all 
hours,  and  by  their  use  the  floors  of  the  buildings  may  be 
kept  clean  at  less  expense  than  they  could  be  without  them. 

It  is  not  desirable  to  erect  large  buildings.  The  larger 
they  are  the  more  difficult  is  the  problem  of  ventilating 
every  part  and  getting  sunlight  into  their  interiors.  More- 
over, it  is  a  departure  from  the  colony  idea  and  from  home- 
like principles.  Buildings  should  not  be  over  two  stories  in 
height,  and  they  should  be  planned,  as  far  as  practicable,  so 
that  the  upper  floors  may  be  occupied  as  dormitories  and 
vacated  during  the  day  while  being  ventilated  through  open 
windows.  All  should  have  cellars,  both  for  sanitary  con- 
siderations and  for  the  facility  thus  afforded  of  introducing 
and  looking  after  the  plumbing  and  heating  apparatus,  etc. 
The  cellars  should  have  hard  cement  floors.  The  per  capita 
cost  of  construction  is  about  the  same  for  three-  and  four- 
story  buildings  as  for  those  of  two  stories,  for  the  reason 
that  the  higher  the  building  the  stronger  must  be  the  sup- 
porting walls  and  beams  to  bear  the  weight  of  the  super- 
structure and  the  strain  against  the  wind. 

The  tendency  in  establishing  colonies  for  epileptics  is  now 


36  CARE  AND  TREATMENT  OF  EPILEPTICS. 

towards  smaller  cottages  with  a  capacity  of  from  ten  to 
twenty  patients.  Some  labor  under  the  impression  that 
larger  buildings  would  mean  economy  in  administration.  I 
think  it  safe  to  say  that  medical  experience  is  opposed  to 
this  view  on  the  ground  that  reasonable  economy  may  be 
attained  in  the  smaller  structures  with  more  satisfactory  re- 
sults in  every  way.  The  term  cottage  has  lost  its  original 
meaning  by  present  usage  and  has  come  to  be  inappro- 
priately applied  to  a  building  that  may  contain  one  hundred 
or  more  persons.  The  term  as  here  used  is  intended  to 
apply  to  buildings  for  living  purposes,  designed  to  accom- 
modate a  single  group  numbering,  say,  from  ten  to  thirty 
patients. 

In  size  of  buildings,  design,  and  arrangement,  everything 
that  suggests  an  institution  should  be  avoided.  One  may 
drive  along  the  main  road  leading  through  the  colony  of 
Alt-Scherbitz  and  hardly  be  aware  that  he  is  passing  a 
public  charitable  institution.  Not  only  in  the  design  for 
improvements,  but  in  the  selection  of  a  name,  the  same 
thought  should  be  observed.  The  word  epileptic  should  be 
omitted,  that  its  beneficiaries  may  not  be  continually  and 
unnecessarily  reminded  of  their  peculiar  infirmity.  A  name 
can  readily  be  chosen  indicating  a  community,  colony, 
village,  home,  or  collection  of  homes. 

All  workshops  and  workrooms  should  be  well  lighted. 
Window  space  costs  no  more  than  blank  wall  space ;  and  as 
work  can  be  performed  better  with  an  abundance  of  light, 
and  as  well-lighted  apartments  are  more  healthful,  they 
should  be  provided.  Skylights  are  objectionable,  and  the 
plans  should  be  such  as  to  afford  abundant  light  without 
them. 

Kitchens  and  laundries  should  be  but  one  story  in 
height,    and   should  have  high  ceilings.     They  should  be 


CONS  TR  UC  TION.  3  7 

constructed  so  as  to  permit  the  vapor,  steam,  and  gases  to 
pass  quickly  away.  For  obvious  reasons,  kitchen  and 
laundry  apartments  should  never  be  in  basements. 

Heretofore  it  has  been  generally  considered  that  brick 
and  stone  were  the  only  suitable  materials  to  be  used  in  the 
building  of  State  institutions.  The  experience  in  the  use 
of  wooden  buildings '  in  some  public  charitable  institutions 
raises  the  question  whether  wood  for  two-story  cottage 
dwellings  may  not  enter  more  largely  into  their  construc- 
tion. In  the  use  of  brick  or  stone  greater  precautions  must 
be  taken,  at  increased  cost,  to  guard  against  dampness. 
Brick  absorbs  a  great  deal  of  moisture,  which  is  an  element 
of  disintegration  when  frozen,  and  is  not  a  durable  material 
unless  it  be  painted  and  the  painting  from  time  to  time  re- 
newed. Wood,  if  laid  on  dry  stone  foundations  and  kept 
well  painted,  may  last  for  centuries. 

Fires  usually  originate  in  dwellings  from  the  inside,  and 
a  wooden  building  is  therefore  as  safe  as  a  brick  one,  except 
in  a  general  conflagration,  which  would  hardly  occur  in  a 
colony  with  a  good  water-supply  and  a  trained  fire-corps,  in 
addition  to  a  subordinate  trained  corps  in  each  household, 

1  At  the  Craig  Colony  there  is  a  pleasant  wooden  cottage  now  occupied  by 
epileptic  patients  that  is  apparently  in  as  good  condition  as  when  it  was  built 
forty  years  ago.  It  is  two  stories  high,  with  tin  roof.  It  occupies,  exclusive 
of  a  broad  veranda  and  a  small  rear  extension,  34  x  51  feet  on  the  ground. 
The  interior  is  so  divided  as  to  give  a  broad  hall,  a  large  pleasant  room  for  two 
attendants,  a  dining-room,  kitchen,  pantry,  scullery,  water-closet,  bathroom, 
and  ample  dormitory  and  sitting-room  space  for  twelve  patients.  The  build- 
ing has  blinds  and  a  veranda  ten  feet  broad  extending  the  full  length  of  its 
front.  When  I  last  saw  it  on  a  summer's  day,  its  veranda  was  hung  with 
Japanese  screens,  and  a  number  of  women  in  easy-chairs  were  sewing  and 
knitting  upon  it,  presenting  a  scene  of  homelike  comfort  and  contentment. 
This  building  would  now  cost  by  careful  estimate  $2400,  including  heating 
and  plumbing.  This  estimate  is  for  a  substantial  structure  on  stone  founda- 
tion, with  cellar,  the  frame  sheathed  within  and  without,  having  felt  lining 
under  the  clapboards,  and  the  horizontal  lath  laid  on  vertical  strips  of  the 
same,  allowing  the  mortar  to  clinch  against  the  woodwork,  making  a  solid, 
warm,  and  dry  wall. 


38  CARE  AND  TREATMENT  OF  EPILEPTICS. 

and  a  night-watch.  With  hydrants  on  each  floor,  and  hose 
attached,  it  would  seem  that  the  danger  from  fire  would  be 
reduced  to  the  minimum. 

Two-story  wooden  cottages  can  be  tastefully  constructed, 
with  pleasing  exteriors  and  convenient  interiors,  at  a  com- 
paratively low  expenditure.  I  think  it  safe  to  say  that 
dwellings  of  this  character  suitable  for  epileptics  may  be 
built  and  furnished  with  facilities  for  heating  and  lighting 
at  a  cost  not  exceeding  $200  per  capita,  and  that  these 
will  average  better  in  quality  than  the  average  of  farmers' 
dwellings  in  prosperous  sections  of  the  country.  I  would 
not  recommend  the  entire  substitution  of  wood  for  brick, 
even  for  moderate-sized  structures,  but  it  would  seem  well 
to  give  wooden  dwellings  a  trial  on  a  limited  scale. 

If  brick  can  be  made  on  the  place  by  the  patients  in  suffi- 
cient quantities  for  building  purposes,  the  question  of  cost 
would  favor  the  use  of  brick.  Not  only  have  some  of  the 
houses  at  the  Bethel  Colony,  near  Bielefeld,  been  planned 
by  epileptics,  but  the  brick  for  them  was  made  by  epi- 
leptic patients.  The  carpentry,  ironwork,  painting,  and 
glazing  were  also  done  by  epileptic  workmen.  What  has 
been  found  practicable  at  the  Bethel  Colony  may  be  possible 
elsewhere. 

It  is  not  intended  to  go  into  details  of  construction,  finish, 
or  furnishing ;  but  a  few  points  are  deemed  worthy  of  special 
attention  in  an  institution  for  epileptics.  The  corners  of  all 
woodwork,  like  newel-posts,  baseboards,  etc.,  should  be 
rounded;  stairways  should  have  broad  treads,  easy  risers, 
and  to  every  flight  two  or  more  broad  landings,  for  the  pur- 
pose of  preventing  or  lessening  injury  to  patients  who  fall. 
Heating  and  ventilation  should  receive  careful  attention, 
and  the  systems  adopted  should  be  such  that  patients  may 
not   be  liable  to  injury   from    the  apparatus   and   fixtures 


CONS  TR  UC  TION.  39 

used.  Ventilation  may  be  promoted  by  open  fires  properly 
screened,  and  they  add  so  much  to  the  cheerfulness  of 
apartments  in  gloomy  weather  that  I  cannot  too  strongly 
urge  their  use.  Dr.  Osborne  very  happily  reflects  my  views 
respecting  open  fires  in  the  following  language : 

"  Our  open  fireplaces,  carefully  protected  by  ample  screen 
guards,  keep  the  most  perfect  ventilation  under  the  severest 
tests,  and  give  at  the  same  time  such  a  sense  of  warmth  and 
comfort  to  the  whole  building  as  cannot  be  described.  A 
source  of  physical  comfort  by  day,  they  are  a  sweet  medi- 
cine to  restless  bodies  and  aching  brains  at  night.  There 
is  a  world  of  comfort  in  an  open  fireplace  for  the  well, 
and  to  these  patients  the  influence  is  fourfold.  I  re- 
call many  stormy  winter  nights,  when  the  rain  outside  was 
falling  in  a  steady  downpour,  or,  perhaps,  with  a  cool  wind 
blowing,  was  dashing  against  the  windows,  or  rattling 
against  the  roof,  that  I  have  quietly  made  the  tour  of  the 
wards  to  note  the  sense  of  absolute  peace  and  comfort  that 
reigned  supreme.  In  the  capacious  fireplaces  the  night-log 
had  been  carefully  fixed  in  place,  the  dormitory  lights 
turned  down  to  a  glowing  speck,  and  the  pathetic  little 
faces  would  be  found  all  turned  towards  the  sputtering  log 
on  the  hearth.  Perhaps  they,  too,  saw  images  in  the  coals. 
Those  to  whom  bedtime  brought  a  period  of  tossing  and 
unrest,  and  those  subject  to  wakefulness,  all  found  in  the 
open  fire  a  never-failing  attraction.  Some  would  be  con- 
tent to  lie  with  their  faces  to  it,  others  rested  on  elbows, 
now  and  then  one  would  sit  up,  all  wrapt  in  mute  attention, 
till  eyelids  drooped  and  muscles  relaxed,  and  murmurless 
they  sank  to  sleep." 

From  opinions  expressed  by  superintendents  of  institu- 
tions where  the  experiment  has  been  tried,  I  conclude  that 
unplastered  walls  are  not  satisfactory.     At  first  thought  it 


40  CARE  AND  TREATMENT  OF  EPILEPTICS. 

would  appear  that  there  would  be  considerable  economy  in 
this  method  of  construction;  but,  as  a  better  quality  of 
brick  is  required,  and  as  the  brick  must  be  laid  with  great 
care,  the  difference  in  expense  is  overbalanced  in  favor  of 
plastered  walls.  A  hard-finish,  plastered  wall  painted  a 
pleasing  tint,  and  washed  and  repainted  as  frequently  as 
desired,  does  not  absorb  poisons  and  has  a  more  homelike 
appearance,  especially  in  living-rooms.  The  brick,  un- 
plastered  walls  will  answer  for  stables  and  outbuildings,  but 
they  are  not  suitable  for  homes  or  the  office  and  living 
departments  of  charitable  institutions. 

For  the  same  reason  that  casings,  newel-posts  and  rail- 
ings should  be  rounded,  furniture  should  have  no  sharp, 
obtruding  angles.  It  is  desirable  that  there  should  be  a 
variety  of  furniture,  including  easy-chairs,  in  the  sitting- 
rooms.  Departments  occupied  by  women  and  those  of  the 
better  class  for  men  should  have  floor  rugs,  and  hallways 
should  have  a  strip  of  carpet  or  cork  linoleum  laid  through 
the  centre.  Sitting-rooms  may  be  made  attractive  by 
pictures  on  the  walls  and  flowering  plants  at  the  windows, 
which  the  patients  may  be  encouraged  to  cultivate.  All 
means  that  can  make  indoor  life  pleasant  should  be  adopted. 

Soft  shades  of  color  should  be  used  for  buildings.  Such 
tints  as  will  harmonize  with  the  landscape  in  which  the 
buildings  are  set  and  at  the  same  time  present  a  cheerful 
aspect  are  the  most  desirable.  Sombre  tints  should  be 
avoided.  The  attractiveness  of  a  building  depends  much 
upon  its  color.  White  is  trying  to  the  eye,  and  should 
not  be  used  unless  it  is  almost  entirely  hidden  by  green 
foliage.  A  large  white  building  standing  out  boldly  in  the 
landscape  is  not  in  keeping  with  natural  objects,  and  offends 
one's  aesthetic  sense. 

Classification. — The  importance  of  extended  classification 


CLA  SSIFICA  TION.  4 1 

in  institutions  for  epileptics  is  felt  by  all  having  charge  of 
them.  The  distinctions  are  numerous.  Of  necessity  the 
sexes  must  be  separated ;  adults  must  be  separated  from 
girls  and  boys;  the  infirmary  cases  of  both  sexes  must  be 
separately  provided  for;  and  if  we  make  but  two  classes 
based  on  social  distinctions  and  habits,  we  have  reached 
eight  classifications  before  making  any  for  different  mental 
conditions. 

At  the  Bethel  Colony,  as  a  general  rule,  the  patients  are 
provided  for  in  houses  containing  about  twenty  persons,  the 
patients  being  classified,  as  far  as  may  be,  according  to  their 
various  conditions  and  capabilities. 

The  classification  of  epileptics  should  extend  to  children 
as  well  as  adults.  In  the  Zurich  institution  Dr.  Kolle  has 
separated  them  into  three  divisions :  the  normally  intelli- 
gent, moderately  feeble-minded,  and  those  decidedly  feeble- 
minded. He  finds  in  that  institution  that  there  are  about 
30  per  cent,  of  the  first  class,  about  50  per  cent,  of  the 
second,  and  about  20  per  cent,  of  the  last  named.  The 
younger  male  children  may  be  kept  on  the  female  side  of 
the  institution. 

In  the  establishment  of  the  Ohio  Hospital  for  Epileptics 
provision  was  made  for  the  admission  of  insane  epileptics. 
In  the  founding  of  the  Craig  Colony,  upon  the  recommen- 
dation of  the  State  Board  of  Charities,  insane  epileptics  were 
excluded,  and  provision  was  made  for  the  transfer  to  State 
hospitals  for  the  insane  of  epileptics  becoming  permanently 
insane  at  the  colony.  The  overcrowded  condition  of  the 
insane  hospitals  in  Ohio  at  the  time  the  Ohio  Hospital  for 
Epileptics  was  founded  was  doubtless  the  controlling  factor 
in  making  that  a  mixed  institution,  as  by  removing  the 
insane  epileptics  from  the  State  hospitals  for  the  insane 
greater   accommodation  for  the    non-epileptic    insane   was 


42  CARE  AND  TREATMENT  OF  EPILEPTICS. 

secured,  for  which  there  was  a  pressing  demand.  While 
provision  should  be  made  in  every  epileptic  colony  for  those 
becoming  for  a  time  mentally  disturbed  and  excited,  it 
seems  manifest  that,  when  epileptics  have  reached  a  condi- 
tion of  permanent  insanity,  they  should  be  transferred  to 
departments  of  hospitals  for  the  insane  specially  provided 
for  them.  At  Bethel,  as  in  some  other  European  in- 
stitutions, cases  of  actual  insanity  are  sent  to  insane  asylums. 
A  colony  for  epileptics  is  deprived  of  the  homelike  charac- 
ter an  institution  of  this  kind  should  have  by  making  per- 
manent provision  therein  for  any  considerable  number  of 
insane  persons,  whose  presence  must  exercise  a  depressing 
influence  over  those  susceptible  of  improvement.  A  desir- 
able classification  of  epileptics  cannot  be  effected  so  satis- 
factorily in  small  institutions  as  in  those  on  the  colony  plan 
accommodating  at  least  from  300  to  400  patients. 

Hospital  and  Infirmary  Accommodation. — The  numerous 
buildings  of  a  colony  should  include  a  hospital  for  those 
suffering  from  acute  diseases  and  accidents,  and  ample  in- 
firmary provision  for  enfeebled  and  bedridden  patients. 
Buildings  for  hospital  purposes  should  be  constructed  in 
accordance  with  modern  scientific  principles. 

Provision  for  Patients  Temporarily  Irresponsible.  —  For 
temporarily  irresponsible  and  excited  patients  a  separate 
building  should  be  provided,  so  remote  from  other  cottages 
that  the  inmates  will  not  disturb  other  patients  of  the 
colony.  The  progress  of  mental  disturbance  and  excite- 
ment  lasting  from  twenty-four  hours  to  a  week  is  regarded 
by  eminent  physicians  as  a  condition  that  other  patients 
should  not  witness. 

Assembly -Room,  etc. — There  should  also  be  provided  an 
assembly-room  for  amusements  and  entertainments,  and  a 
gymnasium  with  billiard-room  for  indoor  recreation. 


BUILDINGS.  43 

Administration  Building. — What  is  termed  the  adminis- 
tration building  is  usually  an  imposing  and  unnecessarily- 
expensive  structure,  in  which  are  the  superintendent's 
residence,  offices  for  himself  and  resident  physicians  and 
steward,  and  living-rooms  for  at  least  a  portion  of  the  staff 
and  nurses.  For  a  colony,  the  administration  building 
should  be  a  plain,  inexpensive  structure,  not  more  than 
two  stories  in  height,  and  it  should  be  strictly  a  service 
building,  containing  only  business  offices.  The  officers 
with  families  should  live  in  separate  homes  and  dwellings, 
as  in  ordinary  life.  This  plan  has  proved  satisfactory,  and 
it  saves  large  expense,  and  does  not  give  an  institutional 
character  to  the  place. 

Accommodations  for  Officers  and  Employees. — In  providing 
accommodations  for  officers,  especially  for  nurses,  it  is  de- 
sirable that  their  quarters  should  be  made  attractive  within 
and  without,  and  reasonable  provision  be  made  in  the  way  of 
real  comforts.  Their  apartments  should  be  so  withdrawn 
from  the  scene  of  their  labors  while  on  duty  as  to  make 
the  respite  from  their  mental  and  physical  strain  a  season 
of  rest  and  recuperation. 

There  should  be  a  separate  two-story  building  with  its  sit- 
ting-room, dining-room,  library,  kitchen,  and  dormitories  for 
the  accommodation  of  certain  officers  not  having  families. 
The  superintendent,  steward,  and  farmer,  if  having  families, 
should  be  provided  with  separate  residences.  The  houses 
for  subordinate  officers  and  employees  should  be  of  reason- 
able size,  to  insure  comfort  and  convenience  and  make  them 
desirable  homes. 

Laboratory  and  Morgue. — So  much  attention  is  now  de- 
voted by  medical  men  to  the  scientific  study  of  epilepsy 
that  it  seems  unnecessary  to  urge  the  importance  of  provid- 
ing the  best  possible  facilities  for  prosecuting  researches  in 


44  CARE  AND  TREATMENT  OF  EPILEPTICS. 

this  direction.  The  researches  made  along  correlated  lines 
at  the  Craig  Colony  and  at  the  Ohio  Hospital  for  Epileptics, 
with  their  well-equipped  laboratories,  show  that  great  ad- 
vances have  been  made  by  these  means,  and  lead  to  the 
expectation  of  still  more  important  results.  Moreover, 
these  departments  give  to  the  institution  the  dignity  of  a 
scientific  purpose. 

In  the  location  of  the  morgue  and  laboratory  building, 
which  should  include  a  chapel  or  suitable  room  for  religious 
mortuary  services,  a  secluded  spot  should  be  chosen  and  the 
building  screened  from  observation  by  planting.  It  should 
be  accessible  by  private  road  to  friends  or  relatives  desiring 
to  remove  the  remains  of  deceased  patients.  A  building 
known  to  be  used  for  purposes  of  dissection,  standing 
prominently  on  the  grounds,  cannot  but  have  a  depressing 
influence  upon  patients  who  are  naturally  moody  and  mel- 
ancholy and  many  of  whom  regard  the  process  of  dissection 
with  horror.  Everything  that  can  depress  the  minds  of 
patients  or  suggest  unpleasant  thoughts  should  be  avoided. 

Protection  against  Fire. — There  should  be  hydrants  upon 
every  floor,  with  hose  always  attached,  and  other  usual 
means  for  extinguishing  fires,  including  portable  extin- 
guishers. Patients  should  be  trained  systematically  as  to 
what  to  do  and  how  to  leave  a  building  in  case  of  an  alarm 
of  fire.  Such  training  gives  them  self-possession  and  pre- 
vents a  panic  if  a  fire  occurs.  Fire-escapes  should  be 
provided  for  all  dormitories  on  the  second  floor.  The 
importance  of  having  strict  night  supervision  over  all  the 
buildings  and  premises  should  not  be  overlooked. 

Water-Supply. — Assuming  that  a  bountiful  supply  of 
water  is  obtainable,  not  only  for  the  present  but  for  the 
future  growth  of  the  institution,  a  liberal  expenditure  is 
warranted  to  secure  the  best  means  of  making  it  available. 


WA  TER-SUPPL  Y — SE  WERA  GE.  4  5 

The  system  adopted  should  be  such  as  to  afford  a  copious 
supply  at  all  times  and  for  all  purposes.  If  two  systems 
are  adopted — one  for  supplying  water  for  drinking  and  for 
culinary  uses,  and  the  other  for  all  other  purposes — it  will 
be  found  that,  if  a  tower  or  upright  cylinder  is  used,  an 
upright  cylinder  of  much  less  capacity  may  be  placed 
within  the  larger  cylinder  with  economy,  and  this  arrange- 
ment will  result  in  some  other  advantages. 

Disposal  of  Waste. — The  disposal  of  sewage  in  a  colony 
where  there  are  numerous  buildings  and  many  of  them 
widely  separated  is  a  matter  of  great  moment,  and  more 
difficult  of  solution  than  where  a  great  building  on  the  con- 
gregate plan  may  be  accommodated  by  one  large  trunk 
sewer  conveying  the  asylum  waste  to  a  large  and  rapid- 
flowing  river  or  to  a  filter-bed.  The  success  of  intermittent 
filtration-beds  depends  largely  upon  the  nature  of  the  soil 
where  they  are  located  and  conditions  as  to  grade.  It  is 
therefore  important  that  these  should  be  well  considered 
before  an  outlay  is  made,  otherwise  the  results  may  not  be 
satisfactory.  The  system  of  disposing  of  the  faeces  by  dis- 
solution in  water,  thus  greatly  increasing  the  volume  of  fetid 
matter,  the  solids  of  which  must  afterwards  be  separated 
from  the  liquid,  is  an  expensive  and  troublesome  one  to 
maintain.  Scientific  investigations  and  experiments  now 
making,  may  develop  some  process  of  cremation  that  will  be 
practicable  and  desirable  for  the  disposal  of  sewage  of 
isolated  dwellings. 

The  use  of  dry  earth  in  the  absorption  of  waste  about 
stables,  piggeries,  closets,  and  elsewhere  is  advantageous  in 
purifying  unwholesome  quarters  and  in  the  production  of 
fertilizing  material.  While  the  dry  earth  may  be  readily 
obtained  during  the  summer,  it  is  necessary  to  store  away  a 
sufficient  quantity  for  use  during  the  winter  months  and  the 


46  CARE  AND    TREATMENT  OF  EPILEPTICS. 

rainy  seasons.  The  earth  should  be  dried  in  vats  with 
covers  made  to  shift  on  rollers,  the  same  as  are  used  in  the 
salt-fields  in  manufacturing  salt  by  solar  evaporation.  After 
thoroughly  drying  the  earth,  it  should  be  shovelled  into  ad- 
joining sheds  having  floors,  underneath  which  is  a  free 
circulation  of  air.  In  this  way  a  natural  deodorizer  and 
disinfectant  may  be  provided  for  all  seasons,  the  utility  of 
which  is  recognized  by  the  brute  creation  as  well  as  by  man. 

Electric  System. — Convenience  and  economy  will  be  found 
in  lighting  buildings  by  electricity.  The  electric  system 
may  also  furnish  motive  power  in  the  shops  and  elsewhere. 
Under  some  circumstances,  in  a  colony  covering  a  large 
area,  it  is  thought  that  electric  tramways  are  advantageous 
in  transporting  persons,  farm  products,  and  various  kinds 
of  material  from  point  to  point,  tending  to  centralize  the 
administration.  With  the  same  object  telephonic  com- 
munication should  be  had  with  different  departments. 

Farmstead. — The  farmstead,  or  agricultural  buildings,  of 
the  colony  is  important,  and  should  form  a  separate  de- 
partment. The  barns  and  stables  should  be  capacious. 
The  former  should  have  basements,  ample  floor  space  above, 
and  two  main  doors  on  the  same  side  of  the  building, 
permitting  of  the  driving  in  by  one  and  out  by  the  other. 
The  posts  should  be  high,  and  the  roof  hipped,  to  afford 
liberal  space  for  the  storage  of  grain  and  fodder.  A  cellar 
for  roots  should  be  accessible  from  the  basement,  and  if 
ensilage  is  used,  a  silo  also.  From  both  of  these  a  tramway 
or  trolley  should  deliver  food  to  the  stalls. 

An  advantageous  arrangement  for  a  farm  group  has  been 
found  in  locating  the  barn — which  is  at  the  best  a  formal- 
looking  structure — a  goodly  distance  in  the  rear  of  the 
farmer's  residence,  on  each  side  of  which  might  be  placed  a 
cottage    for   patients  working  upon  the  farm.     On  either 


FOOD.  47 

side  of  the  space  between  the  farmer's  residence  and  the 
barn  might  be  erected  a  range  of  stables,  sheds,  repair  shops, 
and  other  buildings  belonging  to  the  farm  establishment. 
Thus  would  be  formed  a  large  court  back  of  the  farmer's 
residence.  From  the  back  porch  of  his  house  the  farmer 
could  command  a  full  view  of  all  the  buildings  and  the 
operations  about  them.  The  buildings  should  be  plain  and 
the  barns  so  constructed  that  interior  beams  will  not  ob- 
struct the  free  unloading  of  fodder  by  means  of  ridge 
carriers.  The  farmstead  group  should  be  screened  by  the 
judicious  planting  of  large-growing  shade  trees. 

Food. — The  matter  of  food  is  of  great  importance.  Ex- 
periments are  now  making  in  dietary  tables,  and  the  kinds 
of  food  best  suited  to  the  peculiar  phases  of  the  disease  and 
the  condition  of  the  patient  are  now  carefully  studied  in 
different  institutions.  The  results  should  be  constantly 
watched  and  such  changes  made  from  time  to  time  as  will 
best  promote  the  welfare  of  the  patients.  The  gardens  and 
orchards  of  the  institution  should  be  developed  to  meet  the 
full  needs  of  the  inmates  in  variety,  quality,  and  quantity 
of  fruits  and  vegetables. 

Much  depends  upon  the  preparation  of  the  food  in  making 
it  palatable  and  wholesome.  None  but  an  expert  cook 
should  be  employed,  and  the  kitchen,  as  well  as  the  labor- 
atory, should  receive  a  share  of  the  medical  officer's 
attention.  If  the  food  is  properly  prepared  and  made 
acceptable,  economy  will  result. 

Not  only  should  the  food  be  well  cooked,  but  it  should 
be  properly  served,  and  sufficient  time  should  be  taken  to 
do  this.  An  appearance  of  ' '  mussiness  ' '  should  be  avoided. 
To  serve  a  meal  hastily  and  heedlessly,  as  brute  animals  are 
sometimes  fed,  often  disgusts  the  patient  and  destroys  his 
appetite.     Many  patients  have  been  accustomed  to  decor- 


48  CARE  AND    TREATMENT  OF  EPILEPTICS. 

ous  ways  of  living,  and  they  are  much  disturbed  by  the  non- 
observance  of  rules  of  home-life  etiquette,  which  are  absent 
in  some  large  institutions.  Moreover,  attention  given  to 
these  details  has  a  refining  influence  upon  all.  Food  should 
not  be  put  upon  the  table  until  the  patients  are  seated,  and 
then  it  should  be  placed  there  in  an  orderly  and  becoming 
manner,  warm  dishes  being  brought  in  fresh  from  the  range. 
The  method  pursued  in  the  Ohio  institution  of  serving  the 
meals  in  courses  commends  itself  to  general  adoption. 
Dining-rooms  should  be  well-lighted,  cheerful  apartments 
and  have  pleasant  lawn  outlooks.  Flowers  in  their  season 
should  decorate  the  tables,  and  the  feet  of  chairs  should  be 
protected  with  rubber  tips,  to  prevent  the  nerve-tearing 
screech  made  by  their  movement  upon  a  bare  floor. 

Education. — Epileptic  children  should  be  educated  ac- 
cording to  their  capabilities.  In  doing  this,  close  discrim- 
ination must  be  made  of  individual  capacities  and  great  care 
taken  that  no  child  is  coerced  beyond  his  continually  vary- 
ing receptive  ability.  The  bent  of  the  pupil's  mind  should 
be  studied  and  his  development  followed  along  the  line  of 
inclination. 

Of  the  necessity  of  educating  epileptics,  Dr.  Spratling,  of 
the  Craig  Colony,  says:  "  When  it  is  realized  that  one  per- 
son in  every  five  hundred  of  the  population  is  an  epileptic, 
and  when  we  further  realize  the  more  important  fact  that 
75  per  cent,  of  all  cases  of  epilepsy  begin  under  twenty 
years  of  age,  .  .  .  and  that,  unless  special  pains  be 
taken  to  correct  the  tendencies  of  the  disease  in  early  life, 
progressive  mental  and  physical  failure  is  sure  to  follow 
— we  can  appreciate  the  great  value  of  the  proper  education 
of  this  class,  especially  when  it  carries  with  it  the  potent 
influences  that  serve  so  materially  to  stay  the  ravages  of  the 
disease.     Not  only,  therefore,  do  we  educate,  but  through 


EDUCATIOX.  49 

the  same  agencies  we  ameliorate  and  cure.  For  no  other 
class  of  dependents  is  it  possible  to  do  these  two  things  at 
the  same  time." 

Secretary  Gaskell  says  that  the  worst  cases  at  Chalfont 
St.  Peter  are  those  that  have  been  epileptic  from  child- 
hood. That  this  is  so  he  attributes  in  most  instances  to  a 
lack  of  education. 

Dr.  Powell  says:  "  Education,  in  its  broadest  sense,  is 
the  chief  hope  of  the  epileptic,  as  it  is  with  the  normal 
child,  only  modified  to  suit  the  strength  of  the  patient." 

Dr.  Kolle,  whose  long  experience  in  the  care  of  epileptics 
enables  him  to  speak  with  authority  respecting  their  require- 
ments, says  :  "  Epileptic  children  ought  to  be,  and  must  be, 
educated.  What  is  to  become  of  them  otherwise  when 
they  are  sixteen,  eighteen,  or  even  thirty  or  forty  years 
old,  especially  if  the  disease  decreases  ?  It  may  be  asserted 
that  every  epileptic,  however  seriously  affected,  will,  when 
not  under  the  influence  of  attacks,  demonstrate  in  himself 
the  results  of  careful  or  neglected  training.  A  badly  trained 
epileptic  is  a  heavy,  almost  unbearable,  burden  to  those 
who  care  for  him,  either  in  an  institution  or  in  the  family." 

The  progress  of  which  epileptic  children  are  capable  is 
forcibly  illustrated  by  Dr.  Kolle  by  comparison  with  chil- 
dren of  brilliant  intellect,  those  of  ordinary  capacity,  and  the 
feeble-minded.  He  says :  "  The  teaching  of  specially  gifted 
individuals  may  be  compared  to  making  the  voyage  of  life 
in  a  splendidly  equipped  ocean  steamer.  The  ordinary 
human  being  travels  in  an  ordinary  vessel,  it  may  be  some- 
times under  steam  and  sometimes  under  sail.  The  idiot 
moves  forward  slowly ;  his  ship  is  a  heavily  laden  freighter, 
which,  however,  in  the  course  of  time  reaches  a  certain 
destination.  The  epileptic  pupil  travels,  in  proportion  to 
his  mental  gifts,  either  by  fast    steamer,   by  an    ordinary 


50  CARE  AND    TREATMENT  OF  EPILEPTICS. 

ship,  or  in  a  heavy  freighter ;  but  every  attack  of  his  malady 
is  like  a  tremendous  ocean  wave,  which  not  infrequently 
sweeps  overboard  all  the  stores  of  the  vessel.  When  teacher 
and  pupil  think  they  have  about  reached  some  harbor 
the  ship  is  tossed  back  from  the  landing  to  the  sea,  and 
it  may  go  down  altogether;  the  epileptic  succumbs  to  his 
attacks  and  the  teacher  feels  inclined  to  let  go  the  rudder 
and  ask,  Wherefore  all  the  hard  work  and  trouble  ?  " 

It  is  the  testimony  of  those  having  experience  in  the  care 
of  epileptic  children  that  home  training  is  not  adapted  to 
their  needs.  Dr.  Kolle  has  given  an  apt  illustration  of  the 
advantages  of  institution  over  home  training  for  epileptics. 
He  says: 

"  It  has  ever  been  an  especially  difficult  task  to  train  sick 
children  properly.  In  the  family  circle  it  is  often  impossible 
to  accomplish  this  end  in  the  case  of  epileptics.  A  clear 
understanding  of  the  physical  condition  of  the  child  is, 
above  all,  necessary ;  and  how  many  parents,  however  well 
educated,  can  fulfil  this  requirement  ?  It  might  prove  no 
more  advantageous  for  the  child  if  the  direction  of  his  train- 
ing were  given  over  to  the  family  doctor,  either  in  whole  or 
in  part.  The  troubled  parents  indulge  the  little  patient  in 
many  ways,  for  the  rule  given  them  for  guidance  is,  '  On 
no  account,  any  excitement. '  Yet  epileptics,  more  than  all 
others,  should  be  strictly  brought  up.  The  so-called  epilep- 
tic character,  with  all  its  repulsive  sides,  must  be  combated 
by  carefully  planned  methods  of  training  from  earliest  child- 
hood. Experience  teaches  that  this  is  possible.  There  are 
very  attractive,  even  charming,  characters  among  epileptics 
when  the  disease  has  not  wrought  too  great  ravages  of 
mind  and  soul;  and  there  are,  on  the  other  hand,  epileptics 
with  a  milder  form  of  disease  who  are  unbearable,  who  are 
disinclined  to  any  work,   who  are  moody,  obstinate,  sus- 


EDUCATION.  51 

picious,  and  selfish ;  in  fact,  classical  types  of  egoism.  The 
causes  which  have  operated  to  produce  such  a  character  are 
easily  comprehended.  Each  attack  makes  the  patient  wish 
to  find  means  to  prevent  the  next;  makes  him  introspective 
and  desirous  of  managing  himself  in  his  own  way. 

"  It  is  easy  to  see  that  an  institution  has  various  means 
of  training  at  its  command  to  facilitate  the  work  of  educa- 
tion. In  it  the  child  becomes  accustomed  to  regularity 
from  morning  to  evening,  without  effort.  Arising,  dressing, 
washing,  eating,  going  to  school,  working,  playing,  all  have 
their  appointed  time  of  day.  A  child  who  was  disobedient 
at  home  obeys  the  command  of  the  institution  bell,  and 
learns  to  carry  out  the  daily  programme  without  dispute. 
The  association  with  other  epileptics  can  in  no  way  be 
deemed  disadvantageous.  It  may  happen  that  a  specially 
sharp  cry  coming  from  one  patient  overcome  by  an  attack 
may  so  frighten  another  as  to  cause  a  convulsion  to  occur  in 
his  case  as  well,  but  such  a  point  is  insignificant  in  compari- 
son with  the  drawbacks  entailed  upon  an  epileptic  by  home 
life.  It  sometimes  has  a  good  educational  effect  for  an 
epileptic  to  see  attacks  in  others.  The  first  impression  is 
necessarily  very  depressing,  but  he  comes  to  the  healthful 
comprehension  of  how  much  those  who  care  for  him  have 
to  bear  in  his  own  case.  Modesty  and  gratitude  are  thereby 
aroused  in  him  instead  of  the  traits  which  form  the  epileptic 
character.  In  some  forms  of  this  disease  he  is  incited 
thereby  to  combat  and  suppress  certain  kinds  of  attacks. 
It  is  a  pretty  outgrowth  of  the  community  life  of 
epileptic  children  that,  as  soon  as  one  is  overcome  by  an 
attack,  the  others  hasten  to  his  aid  and  lay  him  tenderly  on 
a  mattress.  If  we  remember  how  epileptic  children  outside 
of  an  institution  are  avoided  by  others  in  the  schoolroom  or 
at  play,  and  think  of  the  happy  times  which  such  children 


52  CARE  AND    TREATMENT  OF  EPILEPTICS. 

have  together  in  institutions,  we  come  to  believe  in  the 
saying,  '  No  one  is  happy  save  in  the  company  of  his  own 
kind.'  As  soon  as  an  institution  has  acquired  the  suitable 
tone  for  its  sick  children  and  the  proper  atmosphere  is  felt 
within  its  doors,  the  casual  visitor  will,  with  few  exceptions, 
see  happy  faces  and  often  hear  merry  songs." 

Among  epileptic  children  capable  of  receiving  instruction 
will  be  found  almost  every  grade  of  mental  receptivity,  from 
the  very  feeble  intellect  to  that  but  slightly,  and  perhaps 
not  at  all,  impaired  by  disease.  Moreover,  it  is  a  peculiarity 
of  epilepsy  to  cause  irritability,  to  deprive  its  subject  of 
self-control  and  the  ability  to  concentrate  the  powers  of  at- 
tention upon  a  definite  purpose.  Such  various  conditions 
render  classification  necessary  and  make  the  task  of  the 
teacher  a  difficult  one,  who  must  ever  keep  clearly  in  mind, 
not  only  the  intellectual  and  moral  development  of  his 
pupils,  but  the  curing  of  disease.  Other  difficulties  also 
must  be  met, — the  varying  condition  of  individual  pupils, 
the  irregularity  of  attendance  on  account  of  seizures,  and 
interruption  from  attacks  in  the  class-room.  For  the  latter 
a  mattress  upon  which  to  place  the  pupil  should  always  be 
in  readiness  in  an  adjoining  room,  and  the  teacher  must,  of 
course,  know  how  to  care  for  the  unfortunate  one.  If  signs 
of  an  attack  are  visible  the  pupil  should  be  excused  from 
class  and  every  effort  made  to  tide  him  over  the  dangerous 
period.  He  should  never  be  forced,  but  carefully  and  skil- 
fully guided  only  so  far  as  is  consistent  with  his  mental  and 
physical  ability. 

In  the  education  and  training  of  epileptic  children  the 
^development  of  the  higher  intellectual  faculties  is  considered 
of  less  importance  than  the  inculcation  of  such  knowledge 
as  will  be  of  practical  advantage  to  them.  Manual  training, 
for  the  purpose  of  teaching  young  persons  useful  trades 


EMPLO  YMENT.  5  3 

with  a  view  to  their  self-support,  has  come  to  be  regarded 
as  essential  in  a  properly  organized  institution.  As  stated 
by  Dr.  Spratling,  the  primary  aim  in  every  colony  for 
epileptics  should  be  to  cure  the  patient  if  possible.  At  the 
same  time  an  effort  should  be  made  to  educate  and  train 
him  to  useful  and  self-sustaining  labor.  '  The  means  em- 
ployed in  the  colony  system  to  cure,  to  educate  intellec- 
tually, morally,  and  industrially,  and  to  teach  self-support 
are  so  intimately  interwoven  that  they  must  be  considered 
as  one,  and  all  at  the  same  time.  When  they  enter  the 
colony  the  patients'  education  should  be  begun  along  two 
lines,  one  to  give  them  a  common-school  education ;  the 
other  to  put  a  means  in  their  possession  whereby  they  can 
become  producers  as  well  as  consumers,  and  at  the  same 
time  become  themselves  the  effective  agent  in  the  applica- 
tion of  a  remedy  of  untold  value  in  the  treatment  of  their 
disease." 

Employment. — Nothing  tends  to  build  up  the  epileptic  so 
rapidly  as  congenial,  healthy  employment,  especially  that 
out-of-doors,  where  the  sunshine,  fresh  air,  and  surround- 
ings of  nature  draw  his  mind  from  himself  and  his  disease  and 
inspire  within  him  mental  activity  and  hopefulness  in  the 
place  of  despondency  and  gloom.  Among  the  various  kinds 
of  employment  in  which  it  has  been  found  practicable  to 
engage  epileptic  patients  may  be  mentioned  as  first  in  im- 
portance that  afforded  by  agricultural  and  horticultural 
pursuits.  The  benefits  derived  from  the  cultivation  of 
fruits  and  garden  products  cannot  be  overestimated.  Be- 
sides the  immediate  physical  benefit  to  be  derived  in 
recuperating  or  building  up  the  general  health  of  the  epi- 
leptic, the  labor  involved  in  such  occupations  furnishes  an 
abundance  and  a  variety  of  those  kinds  of  food  most  desir- 
able in  the  treatment  of  his  disease.     The  care  of  stock  and 


54  CARE  AND    TREATMENT  OF  EPILEPTICS. 

the  dairy  affords  much  to  be  desired  in  the  way  of  health- 
giving  labor.  If  the  property  of  the  institution  includes  a 
bed  of  good  clay,  brickmaking  is  an  industry  that  should 
receive  early  attention,  and  the  cost  of  buildings  may  be 
lessened  by  using  brick  made  by  the  patients,  aided  by 
skilled  assistants  and  brickmaking  machinery.  If  there  is 
a  good  stone  quarry  on  the  place  it  should  be  early  de- 
veloped for  the  same  reason.  Carpentering,  blacksmithing, 
the  making  of  tinware,  painting,  tailoring,  basket-making, 
cabinet-work,  upholstering,  broom-making,  brush-making, 
printing,  and  bookbinding  are  indoor  occupations  that  have 
also  been  followed  with  advantage. 

For  women,  light  garden  work,  the  care  and  cultivation 
of  fruits  and  flowers,  nearly  every  kind  of  domestic  work, 
including  washing,  making  and  mending  wearing  apparel, 
knitting,  and  fancy  needlework,  may  be  mentioned.  At 
Bielefeld  some  thirty  different  callings  are  followed  by  the 
men  and  women  patients. 

Attendants  having  patients  in  charge  should  not  be  per- 
mitted to  act  the  part  of  an  idle  dictator,  but  should  work 
with  the  patients,  taking  the  lead  in  whatever  they  are 
doing,  and  should  show  by  their  example  that  no  harder 
conditions  are  imposed  upon  patients  than  upon  those 
having  charge  of  them.  This  course  dignifies  their  labor 
and  causes  the  patients  to  work  more  contentedly  than  they 
would  otherwise.  Moreover,  it  resembles  the  farm  system, 
where  the  farmer  works  with  the  hired  workers,  usually 
taking  the  lead  in  their  daily  tasks.  In  many  of  the  Scotch 
asylums  for  the  insane  I  have  observed  that  the  attendant 
took  the  lead  in  both  indoor  and  outdoor  work,  and  that 
he  was  expected  to  do,  and  did,  more  and  harder  work  than 
the  insane  patients  working  with  him.  It  has  been  found 
disadvantageous   to  allow  epileptic  workmen  to  supervise 


CO  MP  ENS  A  TION.  5  5 

other  epileptics.  The  epileptic  patient  at  the  time  of  his 
admission  should  be  made  to  understand  that  he  is  expected 
to  work  to  the  extent  of  his  ability,  not  with  a  view  to 
creating  a  revenue  for  the  institution,  but  for  therapeutic 
reasons. 

Compensating  Patients. — I  found  in  France  some  years 
ago,  and  I  assume  that  the  policy  has  not  been  set  aside, 
that  the  Government  encouraged  the  managers  of  asylums 
for  the  insane  to  compensate  working  patients  in  a  moderate 
degree  for  their  labor.  I  was  told  that  the  plan  worked 
beneficially  and  without  embarrassment  where  it  had  been 
tried.  It  would  seem  that  such  a  custom  might  be  adopted 
with  advantage  in  colonies  for  epileptics,  and  that  a  small 
compensation  might  be  allowed  patients  for  labor  faith- 
fully performed.  The  earnings  might  be  set  apart  and 
disbursed  by  the  management  in  accordance  with  the 
wishes  of  the  patient.  To  justify  a  limited  remuneration, 
it  should  be  explained  to  the  patient  that  the  expense  of 
his  board  and  medical  treatment  is  borne  by  the  institution 
and  must  be  considered  in  making  returns  for  his  labor. 
However  small  the  amount  given,  it  has  been  found  in  the 
case  of  the  chronic  insane  that  their  earnings  afforded  con- 
tentment and  satisfied  a  sense  of  justice,  especially  as  be- 
tween those  who  did  a  great  deal  of  work  and  those  who 
did  little  or  none.  Contentment  of  mind  is  one  of  the 
most  hopeful  conditions  of  epilepsy,  and  a  recognition  of 
services  rendered,  however  slight,  it  is  believed  will  largely 
tend  to  foster  this  feeling.  At  Bielefeld,  some  patients,  the 
poor  ones  especially,  receive  compensation  for  their  services 
in  the  form  of  "  pocket  money,"  which  is  often  used  to  aid 
their  poor  relatives.  There  all  must  work,  not  because  it 
is  of  advantage  to  the  colony,  but  for  the  benefit  to  them- 
selves.     Private  patients  paying  as  high  as  $500  a  year  and 


56  CARE  AND    TREATMENT  OF  EPILEPTICS. 

having  special  accommodations  are  not  exempt  from  this 
salutary  and  inexorable  rule. 

Training  Nurses  and  Attendants. — There  should  be  in 
every  colony  for  epileptics  a  school  or  an  organized  system 
for  training  nurses  and  attendants.  It  is  important  that  in- 
struction should  be  given  in  the  principles  of  rendering  first 
aid  to  the  injured,  in  consequence  of  accidents  from  seizures 
to  which  epileptics  are  subject.  Supplementing  the  natural 
qualifications  of  good  health,  good  sense,  gentleness, 
patience,  and  forbearance  necessary  to  the  efficient  nurse, 
there  must  needs  be  oft-repeated  lessons  having  in  view  the 
inculcation  of  correct  and  orderly  habits,  the  observance 
of  a  respectful  demeanor,  of  strict  propriety  in  all  matters, 
including  cleanliness  of  person  and  dress,  the  exercise  of 
watchfulness,  self-control,  kindness,  and  cheerfulness  in  the 
discharge  of  every  duty,  and  the  furtherance  by  all  practi- 
cal means  of  the  comfort,  happiness,  and  recovery  of  the 
patients.  The  paternal  or  maternal  instinct  is  considered 
by  Dr.  Osborne  a  quality  of  prime  importance  to  those 
having  the  care  of  afflicted  human  beings.      He  says: 

"  Without  the  maternal  or  paternal  instinct  there  cannot 
be  that  patience  which  gives  wisdom  in  the  correction  of 
errors  and  the  guidance  therefrom,  faith  in  the  repetition 
of  moral  precepts,  power  in  the  inculcation  of  lessons,  judg- 
ment in  the  selection  of  topical  training,  calm  endurance  of 
daily  trials  with  the  incorrigible  and  mischievous,  fortitude 
to  resist  the  influences  of  discouraging  phases  of  the  occu- 
pation, and,  lastly,  resignation  to  bear  meekly  yet  coura- 
geously the  burden  lifted  from  parents  and  relatives,  that  the 
child  may  be  brought  to  some  consciousness,  however  little, 
of  its  relation  to  its  associates  and  its  God.  Without  this 
instinct  there  cannot  exist  that  forbearance  so  essential  to 
the  success  of  the  ideal  officer;  that  forbearance  that  leads 


TRAINING   SCHOOLS.  57 

the  officer  to  withhold  from  fretful  complainings,  to  abstain 
from  violent  expressions  of  temper,  to  avoid  arousing  the 
antagonism  of  the  child,  whereby  its  obedience  and  depend- 
ence may  be  imperilled,  and,  finally,  to  forego  all  exhibitions 
and  expressions  of  personal  weakness  and  self-distrust  in 
one's  ability  to  master  quickly  and  satisfactorily  the  peculiar 
emergencies  that  constantly  arise." 

The  attendance  upon  lectures  by  those  under  instruction, 
besides  rendering  their  services  more  efficient,  tends  to 
awaken  in  their  minds  an  interest  in  scientific  subjects. 
They  become  more  observant,  take  greater  pride  in  their 
profession,  have  a  livelier  consciousness  of  its  responsibili- 
ties, and  come  to  feel  a  stronger  benevolent  interest  in 
their  charges.  Moreover,  under  the  training  system,  a 
commendable  rivalry  may  be  established,  giving  better  op- 
portunities for  the  management  to  discriminate  between  the 
capable  and  the  incapable. 

The  system  should  also  include  the  art  of  cookery,  and, 
in  fact,  whatever  relates  to  good  housekeeping. 

The  physician  and  the  educated  nurse  are  mutually  help- 
ful. The  latter,  from  a  closer  association  with  the  patient, 
can  describe  to  the  physician  traits  of  character  and  symp- 
toms of  disease  of  which  he  might  not  otherwise  have 
knowledge,  thus  enabling  him  to  give  more  definite  and 
correct  instructions  for  the  guidance  of  the  nurse. 

Dr.  Delia  E.  Howe,  of  Fort  Wayne,  Ind.,  speaking  from 
experience,  says  upon  this  subject:  "  The  most  important 
of  all  training  for  attendants,  as  well  as  nurses,  is  that 
which  develops  in  them  a  love  for  neatness,  order,  dainti- 
ness, refinement,  gentleness,  and  sweetness  of  disposition. 
Pupils  of  such  a  school  should  be  made  to  understand  from 
the  first  that  their  success  will  depend  on  what  they  them- 
selves are,  or  are  able  to  become ;  and  that  lectures  on  table 


58  CARE  AND    TREATMENT  OF  EPILEPTICS. 

manners,  if  such  are  defective,  are  as  much  a  part  of  their 
education  as  lectures  on  epilepsy.  In  short,  they  must 
enter  the  school  as  pupils,  ready  to  be  taught  anything  in 
which  their  teacher  recognizes  a  deficiency,  from  the  care  of 
their  own  health  to  the  ethical  training  of  their  charges.  .   .  . 

"  Attendants  who  are  not  courteous  to  one  another  and 
to  the  children  can  never  teach  courtesy  to  the  latter,  and 
the  great  aim  of  our  work  with  these  children  is  to  bring 
them  into  more  nearly  normal  relations  with  those  about 
them — to  diminish  in  their  minds  the  relative  importance 
of  '  ego,'  by  increasing  the  attention  they  pay  to  the  people 
and  things  about  them.  I  believe  this  can  in  no  way  be 
better  accomplished  than  by  teaching  them  to  observe  at  all 
times  little  ceremonies  of  politeness ;  always,  of  course,  im- 
pressing upon  them  that  such  ceremonies  are  but  translations 
of  the  heart's  loving-kindness. 

"  The  attendant  who  roughly  orders  a  child  to  '  get  up,' 
and  helps  himself  to  the  latter's  seat ;  who  treads  acciden- 
tally on  a  child's  toe  and  fails  to  beg  his  pardon ;  who  forgets 
to  say  good-night  affectionately  and  good-morning  cheer- 
fully, is  failing  in  the  most  important  part  of  her  duty 
as  an  educator,  even  though  she  be  ever  so  scrupulous  in 
demanding  from  the  child  the  strictest  obedience  and  con- 
stant consideration  of  her  own  personal  dignity." 

Religious  Worship. — Provision  should  be  made  for  the 
proper  observance  of  religious  worship,  and  in  the  oppor- 
tunities offered  the  preferences  of  the  patients,  as  far  as 
practicable,  should  be  considered.  The  mind  of  the  adult 
epileptic  naturally  turns  to  the  serious  side  of  life  and  to  the 
contemplation  of  his  spiritual  needs.  Many  of  this  afflicted 
class  have  strong  convictions  of  religious  duty,  and  find  in 
their  devotions  unspeakable  consolation.      In  some  institu- 


RELIGIOUS    WORSHIP-SUPPORT.  59 

tions  religious  exercises  are  held  daily,  and  no  meals  are 
partaken  of  without  invoking  a  blessing.  The  epileptic  is 
easily  enraged  and  quick  to  retaliate,  but  under  the  sympa- 
thetic influences  of  the  Christian  religion  he  is  more  tract- 
able and  more  disposed  to  exercise  self-control.  One  having 
experience  in  the  care  of  epileptics  says:  It  is  a  well- 
known  fact  that  epileptics  suffer  the  keenest  mental  anguish 
and  sound  all  the  depths  of  despondency  even  to  despair. 
Spiritual  treatment,  therefore,  in  conjunction  with  the 
proper  medical  attention,  is  a  factor  of  no  small  moment  in 
the  management  of  these  poor  children  of  misfortune. 
They  are  susceptible  to  its  benign  influence ;  and  it  is  the 
aim  of  the  spiritual  adviser  to  enkindle  in  their  souls  the 
love  of  God  and  His  Holy  Word,  and  by  cheerful,  kind,  and 
congenial  association  and  the  gentle  guidance  of  Christian 
love  to  remove  from  their  hearts  the  pall  of  gloom  their 
malady  has  cast  over  them.  Such  influence  must  be  exerted 
with  the  utmost  care  and  tact  in  order  to  gain  the  confidence 
of  the  patients." 

Cost  of  Maintenance. — In  view  of  the  expensive  medical 
staff,  the  large  force  of  salaried  nurses,  and  other  officials 
and  paid  employees  under  a  high  system  of  care  in  a  colony 
designed  eventually  to  accommodate  a  large  number  of 
patients,  it  is  expecting  too  much  to  look  for  a  very  low 
rate  of  maintenance  at  the  outset.  This  can  only  be  at- 
tained after  the  colony  or  institution  has  reached  its  maxi- 
mum number.  It  has  been  asserted  in  some  quarters  that 
these  colonies  can  be  made  nearly  or  quite  self-supporting. 
The  truthfulness  of  this  assertion  has  yet  to  be  demon- 
strated. There  is  no  doubt  but  that,  with  a  large  tract  of 
fertile  land,  a  good  industrial  system,  and  prudent  manage- 
ment, they  may  attain  quite  a  low  rate  of  support  as  com- 
pared with  some  other  kinds  of  charitable  institutions. 


60  CARE  AND    TREATMENT  OF  EPILEPTICS. 

The  cost  of  support  is,  however,  a  minor  consideration. 
We  should  first  turn  our  attention  to  ameliorating  the  con- 
dition of  this  long-neglected  and  suffering  class.  It  is  not 
so  much  a  question  of  cost  of  support  as  it  is  one  of  duty 
on  the  part  of  the  State  to  lessen  human  suffering  and  to 
arrest  the  progress  and  minimize  the  causes  of  the  disease. 

Association  for  the  Study  of  Epilepsy. — The  necessity  for 
some  organization  or  society  having  for  its  special  aim  the 
study  of  epilepsy  and  the  care  and  treatment  of  epileptics 
has  long  been  felt  in  America,  and  doubtless  greater  progress 
would  have  been  made  in  benefiting  epileptics  if  such  a 
society  had  been  established  years  ago.  The  success  of 
those  organizations  having  for  their  object  the  study  of  in- 
sanity and  the  care  of  the  insane  and  of  the  physically  de- 
fective and  other  suffering  classes  encourages  the  belief 
that  scientific  study  and  philanthropic  effort  directed  to 
the  needs  of  the  epileptic  may  prove  of  great  benefit  to 
him.  A  movement  with  this  aim  in  view,  under  the 
leadership  of  Dr.  Spratling,  was  put  forward  last  year,  re- 
sulting in  the  formation  of  "  The  National  Association  for 
the  Study  of  Epilepsy  and  the  Care  and  Treatment  of 
Epileptics,"  the  objects  of  which  are  as  follows: 

i.  The  scientific  study  of  epilepsy. 

2.  The  rational  treatment  of  the  disease. 

3.  The  best  methods  of  caring  for  dependent  epileptics, 

including 

a.  The  construction   of   proper  homes  based   upon  a 

study  of  the  epileptic's  needs  as  to  classification 
and  environment. 

b.  The    study    of    the    utilization    of    the    epileptic's 

labor,     for    economic,     scientific,     and     ethical 
reasons. 


STUDY  OF  EPILEPSY.  6 1 

c.  The  study  of  the  best  educational  methods  to  be 
employed,  including  manual,  industrial,  intel- 
lectual, and  moral  forms  and  forces. 

Respecting  the  work,  Dr.  Van  Gieson  says : 

"  In  the  practical  side  of  the  problem,  much  remains  to 
be  done  toward  the  material  welfare  of  these  patients,  and 
a  dissemination  of  the  success  and  importance  of  coloniza- 
tion of  the  epileptics. 

"  As  for  the  scientific  side  of  the  problem,  notwith- 
standing the  brilliant  and  comprehensive  exposition  of  the 
cause  of  epilepsy  by  Hughlings  Jackson,  the  solution  of 
the  question  is  still  unsatisfactory  and  lacking  in  proof. 
From  objective  study,  the  whole  question  of  epilepsy  needs 
working  out  along  radically  new  lines  of  research  which  the 
modern  advances  in  psychology  and  in  the  anatomy  and 
physiology  of  the  nervous  system  enable  us  to  undertake." 

Dr.  Peterson  has  expressed  the  following  opinion  in  rela- 
tion to  the  formation  of  such  an  association : 

"  I  believe  that  such  a  society  would  be  useful,  not  only 
in  calling  attention  to  the  needs  of  this  much-neglected 
class  of  dependents,  but  in  aiding  in  the  foundation  of 
special  institutions  on  uniform  lines  in  all  the  States  of 
the  Union.  I  think  the  purposes  of  the  society  should 
include  such  subjects  as  therapeutics  and  pathology,  also 
pedagogy,  sociology,  etc.,  as  far  as  they  relate  to  the 
care  of  the  epileptic.  The  membership  should  therefore 
comprise,  not  only  physicians,  but  also  every  layman  inter- 
ested in  special  provisions  for  epileptics  and  their  proper 
care  and  treatment." 

Hon.  Wm.  R.  Stewart,  President  of  the  New  York  State 
Board  of  Charities;  Dr.  Wm.  N.  Bullard,  President  of 
the  Massachusetts  Hospital  for  Epileptics;  Dr.  H.  C.  Rut- 


62  CARE  AND    TREATMENT  OF  EPILEPTICS. 

ter,  Manager  of  the  Ohio  Hospital  for  Epileptics,  and  many- 
others,  look  for  good  results  from  such  an  organization. 
Dr.  Rutter  says : 

"  Such  an  association  will,  in  my  opinion,  add  greatly  to 
the  interest  in  the  study  of  epilepsy,  and  also  assist  in  pro- 
viding State  care  in  those  States  which,  at  present,  have 
made  no  provision  for  this  class  of  invalids." 

Awakening  Interest. — In  the  light  dawning  upon  this 
special  field  of  charitable  effort  it  is  gratifying  to  note 
the  great  awakening  that  has  taken  place  during  late 
years,  both  in  Europe  and  America,  to  the  crying  needs  of 
epileptics.  The  efforts  now  being  put  forth,  as  recorded 
in  the  following  pages,  by  eminent  men  and  women,  at 
large  sacrifice  of  time  and  means,  are  deserving  of  earnest 
sympathy  and  hearty  co-operation.  The  advance  that 
has  been  made  in  the  care  and  treatment  of  epileptics 
and  the  acquisition  of  scientific  knowledge  respecting  the 
disease  of  epilepsy  lead  us  to  hope  that  the  time  is  not  far 
distant  when  all  of  this  now  much-neglected  class  will  be 
properly  provided  for,  their  sufferings  alleviated,  and  the 
opportunity  given  them  of  sharing  in  the  common  enjoy- 
ments of  life,  and  that  great  numbers  will  be  permanently 
cured. 


CHAPTER  II. 
OHIO.1 

THE  first  official  expression  in  favor  of  special  institu- 
tions for  epileptics  in  this  country  was  made  by  the 
Ohio  State  Board  of  Charities.  In  1868,  in  its  Second  An- 
nual Report,  the  Board  called  the  attention  of  the  Legislature 
to  the  unhappy  condition  of  epileptics  in  the  poorhouses  of 
the  State,  and  recommended  that  some  better  provision 
should  be  made  for  them.  In  its  Annual  Report  to  the 
Legislature  in  1869  the  views  of  the  Board  assumed  a  more 
tangible  shape,  and  special  separate  provision  was  recom- 
mended in  the  following  language: 

"  An  asylum,  consisting  of  a  farm,  ample  in  size  and  pro- 
ductive in  character,  upon  which  plain,  neat,  and  substan- 
tial pavilions  might  be  erected,  under  the  general  direction 
of  an  accomplished  agriculturist  of  good  administrative 
ability,  aided  by  efficient  medical  skill  and  competent  fore- 
men and  attendants,  would  fully  meet  the  demand.  With 
such  provision,  the  curable  might  be  restored,  the  labor  of 
others,  physically  strong,  properly  developed,  and  the  gen- 
eral comfort  of  all  others  promoted.  Taking  the  class  as  a 
whole,  the  number  competent  to  an  ordinary  day's  labor 
constitutes  a  decided  majority.  This  labor  (itself  a  benefit 
to  the  individual),  under  proper  direction,  might  become 

1  In  the  arrangement  of  the  American  States  those  in  which  there  are  insti- 
tutions for  the  exclusive  care  of  epileptics  are  given  precedence,  the  States 
having  State  institutions  for  this  class  being  first  presented  in  the  order  of  the 
establishment  of  such  institutions. 

63 


64  CARE  AND    TREATMENT  OF  EPILEPTICS. 

not  merely  self-sustaining,  but  actually  remunerative.  The 
Board  are  apprised  of  the  prevalent  incredulity  respecting 
such  enterprises  upon  the  part  of  the  State,  and  yet  the 
amount  of  labor  thus  secured,  if  properly  directed,  upon 
a  farm  ordinarily  productive,  could  scarcely  fail  to  meet  the 
ordinary  current  expenses  of  such  an  institution." 

This  recommendation  was  renewed  in  the  Reports  of  the 
Board  for  the  years  1870  and  1871.  In  the  latter  year,  the 
Legislature,  possibly  finding  it  unpleasant  to  be  importuned 
with  appeals  for  humanity  from  this  source,  abolished  the 
Board,  and  it  was  not  re-established  until  1876,  when  it  re- 
newed its  recommendation  for  State  care  of  epileptics  in 
still  more  earnest  terms.  The  Secretary  of  the  Board,  Dr. 
Byers,  referring  to  some  pitiful  cases  that  had  come  under 
his  notice,  said : 

"  It  must  be  apparent  that  the  exposure  and  neglect  to 
which  this  unfortunate  class  is  subjected  in  our  infirmaries 
is  cruel  to  them,  while  it  exposes  other  quiet  and  inoffensive 
inmates  to  the  danger  always  to  be  apprehended  from  their 
presence.  There  is  an  old  scarred  and  decrepit  epileptic 
now  in  our  State  penitentiary  under  sentence  for  life  for  the 
murder  of  another  epileptic,  who  had  been  his  fellow-lodger 
in  the  old  infirmary  of  Lawrence  County.  There  are  now 
in  several  jails  of  this  State  persons  of  this  class,  whose 
violent  tempers  and  irresponsible  actions  render  their  incar- 
ceration in  close  cells  actually  necessary.  Several  instances 
of  this  kind  came  under  my  observation  during  the  year; 
one  a  case  exceedingly  pitiable — that  of  a  stout  colored 
man  in  the  Stark  County  Jail,  whose  scalp  was  bared  in 
several  places,  and  whose  face  and  body  were  fearfully 
bruised  by  falling  and  beating  against  the  strong,  rough 
iron  bars  of  his  prison-cell.  He  was  held  simply  for  re- 
straint.      Many   of    this  class    are   kept   in    close   confine- 


OHIO.  65 

ment  in  the  filthy  cells  and  foul  air  of  the  '  crazy-houses ' 
of  the  county  infirmaries,  and  their  condition  is,  almost 
without  exception,  unutterably  wretched.  The  case  of 
a  poor  boy  who  had  fallen,  in  an  epileptic  fit,  into  the 
fire,  and  subsequently  was  thrown  upon  the  care  of  the 
Gallia  County  Infirmary,  would,  of  itself,  indicate  the  im- 
portance of  some  better  public  care  for  this  class  of  suffer- 
ers. This  poor  boy's  head  and  the  upper  portions  of  his 
body  were  entirely  denuded,  and  portions  of  the  facial 
muscles  had  been  destroyed.  There  had  been,  apparently, 
no  effort  of  nature  toward  healing,  and,  with  sightless  eyes 
and  raw  and  bleeding  flesh,  I  found  him  lying,  as  he  had 
lain  for  six  months,  a  hideous  spectacle  of  human  suffering, 
without  the  possibility  of  any  alleviation  of  his  condition." 

In  1877,  the  Board  again  brought  forward  a  recommen- 
dation for  a  State  farm  for  epileptics,  and  presented  an 
estimate  of  the  cost  of  300  acres  of  land,  an  administration 
building,  two  pavilions,  eight  cottages,  a  hospital,  shops, 
etc.,  for  the  accommodation  of  500  epileptics.  The  Board 
expressed  the  opinion  that  the  plan  of  a  State  farm  with 
such  or  similar  buildings  would  meet  every  demand  of  their 
condition,  and  that  the  project  could  be  carried  out  at  a 
per  capita  cost  not  exceeding  $560. 

The  oft-repeated,  patient,  respectful  appeals  of  the  State 
Board  of  Charities  at  length  met  with  recognition.  The 
Legislature  of  1877-78  passed  a  resolution  authorizing  the 
State  Board  of  Charities  to  collect  statistics  and  report  their 
conclusions  as  to  what  public  measure  should  be  taken  for 
the  "  protection,  comfort,  and  care  "  of  epileptics. 

In  pursuance  of  this  action,  printed  circulars  were  pre- 
pared by  the  Board  early  in  the  year  and  sent  out  in  June, 
1878,  for  the  purpose  of  obtaining,  as  nearly  as  practicable, 

reports  from  the  several  counties  of  the  number  and  condi- 

s 


66  CARE  AND    TREATMENT  OF  EPILEPTICS. 

tion  of  the  epileptics  therein.     It  was  found  that  there  were 
of  this  afflicted  class  in 

County  infirmaries 417 

'J2 


[58: 


State  asylums 165 

County  jails 64 

Of  the  582  in  the  poorhouses  and  asylums,  303  were  males 
and  279  were  females.  Seventy-one  out  of  321  whose  social 
condition  was  known  were  married  ;  250  were  single.  The 
Secretary  said : 

"  The  actual  condition  of  these  persons  is  such  as  no 
statistical  tables  will  adequately  display.  Any  attempt  to 
describe  in  written  words  must  fall  equally  short  of  convey- 
ing an  idea  of  the  utter  and  abandoned  wretchedness  of  very 
many  of  this  class  now  (if  of  quiet  disposition)  simply  sup- 
plied with  food  and  clothing,  or  (if  dangerous)  caged  and 
chained  in  the  narrow,  dark,  damp,  and  dirty  cells  of  the 
ordinary  infirmary,  jail,  or  madhouse." 

During  the  summer  of  1878,  Commissioner  Brinkerhoff 
and  Secretary  Byers  visited  New  York,  Pennsylvania,  and 
New  Jersey,  conferring  with  specialists  on  the  treatment  of 
mental  diseases,  and  collecting  information  bearing  upon 
the  resolution  of  the  Legislature.  On  the  28th  of  October 
a  meeting  of  the  superintendents  and  trustees  of  insane 
asylums  and  others  interested  was  convened  at  Columbus 
for  a  discussion  upon  the  subject,  at  which  a  resolution  was 
passed  recommending  the  State  Board  of  Charities  to  "  urge 
the  immediate  establishment  by  the  State  of  a  separate 
asylum  for  epileptics." 

With  the  Report  of  the  Board  to  the  Legislature  was  sub- 
mitted a  paper  on  epilepsy  by  Dr.  H.  C.  Rutter,  who  had 
personal  knowledge  of  the  needs  of  epileptics  in  Ohio ;  also 
a  paper  on  the  same  subject  by  Dr.   John  Curwen,  then 


OHIO.  6j 

Superintendent  of  the  Hospital  for  the  Insane  at  Harris- 
burg,  Pa.  Dr.  Rutter  favored  the  creation  of  a  State 
institution,  and  expressed  the  opinion  that  one  could  be 
erected,  suitable  in  all  respects  for  the  proper  classification 
and  treatment  of  epileptics,  for  a  sum  not  to  exceed  $300 
per  capita. 

As  its  conclusion  concerning  provision  for  this  class,  the 
Board  recommended  "  that  the  epileptics  of  the  State 
should  be  provided  for  in  a  colony  by  themselves,  in  cheap 
pavilion  buildings,  and  with  separate  administration."  The 
following  reasons  were  given  for  this  conclusion : 

"  In  making  this  separate  provision  for  epileptics,  it 
should  be  remembered  that  we  not  only  secure  better  treat- 
ment for  them,  and  relieve  our  infirmaries  and  insane  asy- 
lums of  a  grievous  burden,  but  we  also  save  money  very 
largely,  because, 

'  I.  By  thus  aggregating  them,  as  stated  by  Dr.  Rutter, 
we  can  utilize  their  labor,  and  reduce  the  cost  of  attendant 
care  so  that  the  total  expense  of  their  keeping  will  be  very 
much  less,  and,  possibly,  may  be  reduced  fifty  per  cent.,  as 
claimed  by  him ; 

"  2.  The  buildings  for  their  accommodation  will  cost 
much  less  than  those  required  for  ordinary  insane,  and  their 
erection  would  enable  us  to  make  room  in  our  present  hos- 
pitals for  nearly  two  hundred  additional  insane,  for  whom 
accommodations  must  be  provided  sooner  or  later." 

In  conformity  with  a  recommendation  of  the  Governor  in 
his  Annual  Message  to  the  Legislature  and  a  resolution  of 
the  House  of  Representatives,  the  State  Board  of  Charities 
and  members  of  the  Legislature  met  in  joint  convention  on 
January  21,  1879,  xn  tne  ^a^  °f  the  House  of  Represent- 
atives, in  order  that  the  Board  might  present,  more  clearly 
than  could  be  done  in  a  written  report,  the  needs  of  the 


68  CARE  AND    TREATMENT  OF  EPILEPTICS. 

beneficiaries  of  the  State.  At  the  request  of  the  other 
members  of  the  Board,  General  Brinkerhoff  addressed  the 
Legislature  upon  this  occasion.  In  speaking  of  the  care  of 
epileptics,  he  gave  as  the  unanimous  and  emphatic  opinion 
of  the  Board  that  they  should  be  provided  for  in  a  colony 
by  themselves,  in  cheap  pavilion  buildings,  and  with  sepa- 
rate administration.  This  conference  led  to  renewed  dis- 
cussion of  the  subject,  and  a  bill  for  the  establishment  of  a 
separate  institution  for  epileptics  passed  one  branch  of  the 
Legislature. 

In  the  Report  of  the  Board  at  the  close  of  the  year,  the 
Secretary  called  attention  to  the  deplorable  condition  of 
the  397  epileptics  then  in  the  poorhouses.  "  It  is  unneces- 
sary," he  writes,  "  to  repeat  what  has  been  so  often  urged 
upon  the  consideration  of  our  State  authorities  touching  the 
horrors  of  this  malady  and  its  appeals  for  relief.  There  are 
to-day  few  questions  involving  more  distress  in  families  and 
suggesting  greater  difficulties  in  communities  than  the  ques- 
tion of  some  proper  method  of  protection  and  care  for  this 
unfortunate  class." 

In  the  Report  of  the  Board  for  1880,  the  attention  of  the 
Legislature  was  again  called  to  the  need  of  a  State  asylum 
for  epileptics,  and  a  plan  of  an  institution  for  the  accom- 
modation of  585  sane  and  insane  inmates  was  submitted. 
The  plan,  designed  by  Dr.  Rutter,  was  somewhat  similar 
to  that  of  the  insane  asylum  at  Hanwell,  near  London. 

But  for  a  political  upheaval,  involving  changes  in  most 
departments  of  the  government,  which  some  of  our  States 
occasionally  experience,  it  is  probable  that  some  provision 
would  have  been  made  for  epileptics  during  that  year.  The 
State  Board,  however,  with  unflagging  zeal,  repeated  its 
recommendation  for  an  asylum  for  epileptics.  In  its  Re- 
ports for  1882,  1883,  1887,  and  1889,  the  Board  returned  to 


OHIO.  69 

the  question  of  care  for  epileptics,  urging  special  provision 
with  irrefutable  logic. 

On  the  nth  of  April,  1890,  near  the  close  of  the  session, 
the  Legislature  took  the  long-looked-for,  long-hoped-for, 
and  long-prayed-for  action  looking  to  the  establishment  of 
a  separate  State  asylum  for  epileptics.  An  act  was  passed 
providing  for  the  appointment  by  the  Governor  of  a  com- 
mission consisting  of  three  persons  to  determine  upon  the 
manner  in  which  provision  should  be  made  for  the  care  of 
"  the  epileptics  and  the  epileptic  insane  of  the  State."  The 
commission  was  authorized  to  select  and  purchase  a  site 
and  to  adopt  plans  of  fire-proof  buildings,  including  heating, 
lighting,  water-supply,  and  sewerage  systems,  which  should 
provide  complete  accommodations  for  1000  patients.  Under 
this  act  the  following  commissioners  were  appointed :  C.  C. 
Waite,  George  H.  Bunnelle,  and  John  L.  Vance. 

The  site  selected  by  the  commission  was  in  the  extreme 
southeastern  part  of  the  State,  and  consisted  of  105  acres 
of  land,  which  were  purchased  by  the  citizens  of  Gallipolis, 
at  a  cost  of  $35,000,  and  given  to  the  State  for  this  object. 
To  this  gift  125  acres  have  since  been  added  by  purchase. 
The  Legislature  showed  it  had  failed  to  recognize  the  real 
needs  of  an  epileptic  colony  by  limiting  the  amount  of  land 
that  should  be  secured  to  so  small  a  quantity  as  100  acres. 
This  was  contrary  to  the  recommendation  of  the  State  Board 
of  Charities,  which  had  urged  the  purchase  of  a  much  larger 
tract. 

The  act  which  authorized  the  appointment  of  a  commis- 
sion to  select  a  site,  and  appropriated  $12,000  for  their  ex- 
penses, also  provided  that,  after  the  completion  of  their  work, 
there  should  be  appointed  by  the  Governor  a  managing  board, 
consisting  of  five  trustees,  who  should  take  charge  of  the 
erection  of  the  buildings  and  assume  control  of  the  enter- 


JO  CARE  AND    TREATMENT  OF  EPILEPTICS. 

prise.  These  trustees  were  subsequently  appointed,  and 
they  organized  as  a  board  in  February,  1891.  Among  those 
active  in  securing  this  important  legislation,  General  John 
L.  Vance  is  deserving  of  special  mention. 

OHIO    HOSPITAL    FOR    EPILEPTICS. 

In  the  spring  of  1891,  an  appropriation  of  $40,000  was 
made  for  the  erection  of  buildings  for  the  "  Asylum  for 
Epileptics  and  Epileptic  Insane,"  '  the  corner-stone  of 
which  was  laid  November  12,  1891.  On  this  memorable 
occasion  General  Brinkerhoff  made  an  eloquent  and  feeling 
address.  This  long,  unwearied,  courageous  effort  had  at 
last  ripened  into  fruition,  and  Ohio  became  the  banner 
State  in  entering  this  new  field  of  charity,  the  first  in  this 
country  to  provide  State  care  for  a  most  pitiful  class.  The 
founding  of  this  institution  must  have  afforded  profound 
satisfaction  to  the  members  of  the  State  Board  of  Charities, 
and  especially  to  General  Brinkerhoff.  The  large-hearted, 
sympathetic  Dr.  Byers,2  had  he  been  living,  would  likewise 
have  shared  this  feeling.  It  was  also  a  source  of  great 
pleasure  to  Dr.  Rutter  and  other  philanthropists  of  Ohio, 
who  had  specially  interested  themselves  in  the  enterprise. 

In  the  history  of  this  movement  in  Ohio  we  find  a  lesson 
teaching  us  that  by  persistent  effort,  long-continued  and 
dignified  appeals  to  a  legislative  body,  and  by  educating 
the  public  in  its  duties  and  responsibilities,  success  in  phil- 
anthropic enterprises  may  eventually  be  reached. 

By  the  statute  defining  the  mariner  in  which  the  affairs  of 
the  institution  shall  be  administered,  the  trustees  are  em- 
powered  to   provide    the   necessary    administrative    force, 

'In  1892  the  Legislature  changed  the  name  of  the  institution  to  "Ohio 
Hospital  for  Epileptics." 

2  Rev.  A.  G.  Byers,  M.D.,  of  Columbus,  Secretary  of  the  Board  for  nine- 
teen years,  passed  away  November  10,  1890. 


OHIO  HOSPITAL   FOR  EPILEPTICS.  7 1 

medical  skill,  etc.  All  insane  epileptics  whose  disease  has 
developed  during  their  residence  in  Ohio,  together  with  all 
epileptic  persons  who  have  been  residents  of  the  State  one 
year  next  preceding  application  for  admission,  are  admis- 
sible to  the  hospital.  Those  to  be  admitted  are  apportioned 
among  the  several  counties  according  to  their  population. 
When  there  is  accommodation,  private  patients  from  Ohio 
and  elsewhere  may  be  admitted  upon  such  terms  as  the 
trustees  may  determine.  The  trustees  are  required  to  cause 
an  enumeration  of  the  epileptics  in  the  State  to  be  made 
every  four  years.  An  applicant  for  admission  must  furnish 
such  particulars  respecting  his  case  as  may  be  required  by 
the  trustees,  together  with  the  certificate  of  a  physician 
that  the  applicant  is  admissible  under  the  requirements  of 
the  Board  of  Trustees,  and  that  he  is  free  from  any  infec- 
tious or  contagious  disease,  and  from  vermin. 

Sane  epileptics  are  committed  by  the  probate  judge  of 
the  county  of  which  the  epileptic  is  a  resident,  upon  the 
application  of  parents,  guardians,  or  friends,  or  upon  the  ap- 
plication of  any  citizen  in  his  own  behalf.  The  judge  may 
subpoena  witnesses,  including  a  reputable  physician,  to  as- 
certain whether  the  alleged  epileptic  is  a  suitable  person  for 
admission.  The  court  may  then  issue  a  warrant  command- 
ing the  alleged  epileptic  to  be  brought  before  the  probate 
judge,  or,  if  necessary,  the  judge  himself  shall  personally 
visit  the  epileptic  and,  upon  the  certificate  of  said  judge, 
the  proceedings  may  go  on  in  the  absence  of  the  person  in 
whose  behalf  the  application  has  been  made.  The  judge 
may  order  the  physician  in  attendance,  after  examination 
as  aforesaid,  to  make  out  the  necessary  certificate  for  the 
admission  of  the  patient,  in  accordance  with  the  rules  and 
regulations  of  the  Board  of  Trustees.  The  application, 
with  accompanying  papers,  is  then  transmitted  to  the  Man- 


72  CARE  AND    TREATMENT  OF  EPILEPTICS. 

ager  of  the  hospital,  who  advises  whether  the  patient  can 
be  received,  and  if  so,  at  what  time.  If  there  be  accommo- 
dation, the  warrant  of  commitment  may  be  issued  to  the 
sheriff,  to  any  relative  or  friend,  or  to  the  epileptic  himself, 
in  the  discretion  of  the  judge.  The  fees  attending  commit- 
ment are  defrayed  as  in  the  case  of  the  commitment  of 
insane  persons. 

If  it  becomes  desirable  to  transfer  an  epileptic  patient  from 
any  State  hospital  for  the  insane  to  the  Ohio  Hospital  for 
Epileptics,  such  patient  may  be  transferred  upon  the  order 
of  the  Governor,  upon  the  recommendation  of  the  medical 
superintendent  of  such  hospital  and  the  Manager  of  the 
Hospital  for  Epileptics. 

"  The  Board  of  Trustees  are  empowered  to  make  such 
rules  and  regulations  respecting  the  care,  custody,  discipline, 
and  discharge  of  patients  as  they  may  deem  best  for  the  in- 
terests of  the  patients  and  the  State.  All  persons  admitted 
to  the  hospital  as  patients  shall,  until  properly  discharged, 
be  under  the  custody  and  control  of  the  Manager  of  such 
institution,  and  the  Manager  may,  subject  to  such  regula- 
tions as  the  trustees  see  fit  to  adopt,  restrain  and  discipline 
any  patient  in  such  manner  as  he  may  judge  is  demanded 
for  the  welfare  of  the  patient  and  the  proper  conduct  of  the 
institution." 

The  Superintendent,  Dr.  H.  C.  Rutter,  who  is  officially 
designated  as  Manager,  was  appointed  August  7,  1893,  and 
the  hospital  was  opened  for  the  reception  of  250  male 
patients  November  30th  of  the  same  year.  The  assisting 
medical  staff  consists  of  three  physicians  and  a  pathologist. 
The  Superintendent  is  ably  assisted  by  his  wife,  acting  in 
the  capacity  of  matron.  Her  calm  temperament,  kindly 
nature,  and  experience  in  domestic  affairs  make  her  well 
fitted  for  the  discharge  of  her  duties. 


OHIO  HOSPITAL  FOR  EPILEPTICS.  73 

The  hospital  is  situated  on  the  banks  of  the  Ohio  River, 
in  the  outskirts  of  Gallipolis,  a  city  containing  upwards  of 
5000  inhabitants.  The  buildings  stand  upon  an  oblong  ter- 
race of  about  seventy-five  acres,  elevated  thirty  feet  above 
the  river  bottom-lands,  of  which  there  is  a  belt  about  half 
a  mile  in  width  between  the  asylum  and  the  river.  Across 
the  valley  rise  the  wooded  hills  of  West  Virginia,  at  the 
base  of  which  flows  the  river.  Back  of  the  terrace  are  hills 
intersected  by  valleys  and  covered  with  forest  growth.  At 
the  head  of  one  of  these  valleys,  about  half  a  mile  distant, 
is  situated  the  recently  erected  insane  department  of  the  in- 
stitution. In  this  valley  is  a  narrow  strip  of  garden-land. 
At  one  extremity  of  the  terrace  is  a  bold  cliff  fringed  with 
verdure.  A  similar  cliff  peering  from  the  green  foliage  is 
seen  on  the  brow  of  the  range  of  hills  back  of  the  terrace. 
The  eye  takes  in  an  extended  view  looking  down  the  valley 
of  the  Ohio.  In  other  directions  it  is  picturesque,  and  the 
whole  is  pleasing.  The  soil,  however,  is  not  fertile,  and 
the  land  is  so  broken  and  hilly  as  to  make  profitable  farming 
impracticable. 

The  central  building  of  the  institution,  intended  solely  for 
administrative  purposes,  has  not  been  erected.  A  short 
distance  back  of  the  site  for  the  administration  building 
stands  the  one-story  kitchen,  which  includes  seven  cold- 
storage  rooms  of  different  temperatures,  for  the  preservation 
of  various  kinds  of  table  supplies.  These  rooms  are  con- 
nected with  the  ice-plant.  Rearward  from  the  kitchen  is  the 
power-house,  in  which  are  the  huge  boilers,  steam-engines, 
dynamos,  etc.  On  either  side  of  the  kitchen  and  about  fifty 
feet  therefrom  are  the  two  dining-halls — one  for  men  and 
one  for  women.  These  are  two  stories  in  height,  and  have 
a  seating  capacity  of  800  patients.  On  the  upper  floors  are 
several  apartments  for  officers,  and  an  assembly-room.     On 


74  CARE  AND    TREATMENT  OF  EPILEPTICS. 

either  side  of  the  dining-halls  and  a  few  rods  away  is  a 
group  of  two-story  stone  buildings  or  pavilions — one  for 
men  and  the  other  for  women.  Four  buildings  accommo- 
dating 50  patients  each,  and  an  infirmary  accommodating 
j6  patients,  constitute  the  group  for  women.  There  are 
five  pavilions  for  male  patients,  with  a  capacity  for  50 
patients  each,  and  an  infirmary  to  accommodate  j6  patients. 
Cement  walks  are  laid  between  the  different  buildings  and 
to  the  entrance  to  the  grounds.  The  immediate  approach 
to  all  the  patients'  residences  is  so  graded  as  to  do  away 
with  the  necessity  of  steps  at  the  entrance,  thereby  lessen- 
ing the  danger  and  injury  to  patients  when  falling.  The 
first  floors  of  the  pavilions  are  used  for  day-  and  living-rooms, 
and  the  second  floors  for  associated  dormitories,  with  four 
or  five  rooms  for  use  in  case  of  sickness.  The  stairways 
throughout  have  easy  risers,  broad  steps,  and  frequent 
landings. 

All  of  the  pavilions  are  comfortably  and  neatly  furnished, 
those  for  men  being  somewhat  plainer  than  those  for 
women.  All  are  supplied  with  a  few  easy-  and  rocking-chairs. 
Upon  the  floors  are  large  rugs,  curtains  are  at  the  windows, 
and,  in  the  women's  department,  there  is  a  tasteful  ar- 
rangement of  drapery.  There  are  pictures  upon  the  walls 
and  flowers  generally  upon  the  tables  in  the  sitting-rooms. 
In  the  building  occupied  by  boys  is  a  large  playroom. 
Thirty-five  of  the  girls  are  in  one  of  the  pavilions  for  women, 
and  the  remainder  are  distributed  in  other  of  the  women's 
buildings.  Wooden  bedsteads  of  the  French  pattern,  with 
head-  and  foot-boards  and  sides,  are  used  in  some  of  the 
dormitories,  and  in  others  there  are  iron  ones  painted  white. 
Good  horsehair  mattresses  are  in  general  use,  and  all  the 
bedsteads  have  woven-wire  mattresses.  Bright  rugs  are  on 
the  floor  and  a  comfortable  chair  is  beside  each  bed. 


OHIO  HOSPITAL  FOR  EPILEPTICS.  75 

The  basements  have  no  communication  with  the  upper 
floors,  and  are  under  the  special  charge  of  an  engineer. 
The  space  not  otherwise  occupied  is  used  for  dry  storage. 
There  is  a  steam-engine  in  the  basement  of  each  pavilion,  pro- 
pelled by  steam  generated  at  the  power-house  and  brought 
thither  in  a  subterranean  passage,  in  which  are  also  laid  the 
water-,  steam-,  and  gas-pipes,  and  the  wires  belonging  to 
the  electric  system,  which  places  all  the  buildings  in  tele- 
phonic communication  with  one  another.  By  means  of  an 
engine  and  a  fan  in  the  basement  of  each  pavilion,  propelled 
by  steam  from  the  power-house,  good  ventilation  is  effected, 
the  fresh  air  being  taken  from  the  outside.  The  air  in  all 
the  buildings  is  kept  pure ;  even  the  atmosphere  in  the 
closets  is  untainted.  The  dormitories  are  vacated  during 
the  day  and  exposed  to  window  ventilation.  The  heating 
of  the  buildings  by  indirect  radiation  is  effected  by  steam 
from  the  power-house.  Open  fires  are  provided,  not  only 
in  the  sitting-rooms,  but  also  in  the  dormitories.  The 
pavilions  are  provided  with  lavatories,  flush  closets,  and 
bathing  facilities,  all  of  modern  construction.  All  of  the 
buildings  occupied  for  living  purposes  have  screens  at  the 
windows  made  of  No.  8  wire  with  three-inch  mesh.  Dr.  Rut- 
ter  deems  these  screens  necessary  to  prevent  patients  from 
falling  out.  In  one  instance  a  patient  ran  to  the  window  in 
a  fit  of  temporary  aberration,  threw  herself  out,  and  was 
killed.  In  the  insane  department,  not  only  all  the  windows, 
but  the  verandas  also,  are  screened  in  this  way. 

The  laundry,  a  building  of  varied  outline,  is  situated  a 
short  distance  in  the  rear  of  the  pavilions  for  women,  and 
accommodates  seventy-five  patients.  It  has  two  depart- 
ments— one  used  as  a  residence,  a  dwelling  two  stories  in 
height,  with  separate  entrance;  and  the  other  a  working,  or 
laundry,  department,  which  is  one  story  high.     On  the  first 


y6  CARE  AND    TREATMENT  OF  EPILEPTICS. 

floor  of  the  residence  portion  are  two  large  day-rooms  for 
patients,  and  on  the  second  floor  a  large  associated  dormi- 
tory, an  attendants'  room,  and  a  number  of  private  rooms 
for  the  sick.  The  building  is  also  provided  with  the  neces- 
sary rooms  for  offices,  bathrooms,  lavatories,  etc. 

The  industrial  building  is  a  two-story  structure,  with  a 
basement  which  is  used  for  storage  purposes,  for  heating 
apparatus,  etc.  There  are  four  large  rooms  on  each  of  the 
two  floors  above  the  basement.  No  machinery  is  operated 
here,  Dr.  Rutter  believing  that  its  use  is  attended  with  dan- 
ger to  the  patients.  At  present  the  rooms  of  the  industrial 
building  are  devoted  to  the  following  uses:  two  for  sewing- 
rooms,  one  for  mending,  repairing,  and  registering  clothes, 
one  for  upholstering,  one  as  a  carpenter's  shop,  one  as  a 
shoeshop,  one  for  repair  work  and  basket-making,  and  one 
for  the  pathological  laboratory.  The  laboratory  is  under 
the  direction  of  Dr.  A.  P.  Ohlmacher,  assisted  by  Dr.  W.  J. 
Webster.  The  lines  of  work  followed  are  studies  in  gross 
and  microscopic  pathology,  bacteriology,  chemical  pa- 
thology, and  investigations  along  such  clinical  and  therapeu- 
tic lines  as  are  suggested  by  progress  in  this  department. 
Post-mortem  examinations  are  held  in  all  cases,  and  speci- 
mens are  preserved.  Reports  made  at  irregular  intervals 
are  published  in  the  current  medical  journals,  and  then 
collected  and  issued  in  the  form  of  Bulletins. 

The  schoolhouse  for  girls  is  a  one-story  building  fronting 
the  large  lawn  which  separates  the  dining-hall  for  women 
from  the  women's  cottages,  and  some  five  hundred  feet  rear- 
ward from  these  buildings.  The  schoolhouse  is  divided  into 
two  parts,  which  are,  at  present,  used  for  different  sexes. 
It  is  the  intention  to  construct  a  schoolhouse  for  boys, 
which  will  be  situated  in  a  corresponding  location  on  the 
male  side.     Each  department  of  the  present  building  con- 


OHIO  HOSPITAL  FOR  EPILEPTICS.  JJ 

sists  of  a  schoolroom,  a  retiring-room  to  be  used  temporarily 
in  case  of  attacks,  a  lavatory,  and  a  cloakroom. 

The  department  for  insane  epileptics,  a  fire-proof  building 
for  the  accommodation  of  200  patients, — 100  men  and  100 
women, — is  constructed  of  pressed  brick  of  a  light  fawn 
color.  It  stands  upon  the  hillside  and  shows  three  stories 
in  front.  Two  wings  extending  rearward  from  the  main 
portion  of  the  building  are  two  stories  in  height,  and  par- 
tially enclose  a  large  court  in  which  is  located  the  boiler- 
house  for  heating  the  building.  The  asylum  is  independent 
of  the  institution  proper,  except  that  it  is  lighted  by  the 
general  electric  system,  the  bread  consumed  is  supplied 
from  the  general  bakery,  and  the  washing  is  done  in  the 
laundry.  Each  ward  consists  of  day-rooms,  with  access  to 
verandas  on  either  side,  an  associated  dormitory  for  fifty  pa- 
tients, a  dining-room,  an  attendants'  room,  clothing-room, 
lavatory,  bathrooms,  and  six  private  rooms  built  with  suf- 
ficient strength  to  be  used  for  the  isolation  and  seclu- 
sion of  patients  when  necessary.  The  leading  features  of 
the  asylum  are:  first,  simplicity;  second,  its  iron-screened 
verandas  by  which  patients  may  be  freely  admitted  to  the 
open  air  during  any  time  of  the  day.  The  cost  of  the 
asylum,  including  the  power-house  with  its  machinery, 
etc.,  was  $400  per  capita.  It  is  a  substantial,  well-built, 
fire-proof  structure.  Its  estimated  cost,  not  fire-proof,  was 
$300  per  capita. 

All  of  the  buildings,  except  the  insane  asylum,  are  of 
buff-colored  sandstone,  rock-faced.  This  stone  was  taken 
from  a  quarry  on  the  place,  and  sand  and  clay  of  a  good 
quality  for  building  purposes  are  also  found  on  the  estate. 
The  original  plan  of  the  institution,  upon  which  the  first 
buildings  were  erected,  was  on  a  somewhat  grander  scale 
than  that  upon  which  later  buildings  have  been  constructed. 


?8  CARE  AND    TREATMENT  OF  EPILEPTICS. 

The  latter  are  less  pretentious,  but  equally  well,  if  not  bet- 
ter, adapted  to  their  purposes.  The  total  expenditures  for 
improvements  of  every  kind  to  May,  1898,  amounted  to 
$540,000.  It  is  in  contemplation  to  erect  from  future  legis- 
lative appropriations,  in  addition  to  the  administration 
building,  a  hospital  for  each  sex,  which  is  especially  needed, 
a  chapel  building,  and  an  amusement  hall;  also  a  separate 
residence  for  the  Superintendent.  The  administration 
building  will  have  no  dining-room  nor  kitchen.  Here  will 
be  concentrated  all  the  executive  work.  Further  extensions 
are  proposed  as  exigencies  may  demand,  in  the  shape  of  cot- 
tages to  accommodate  from  ten  to  twenty  patients  each,  to 
afford  better  classification  than  can  now  be  had. 

The  buildings  are  lighted  throughout  by  electricity  gen- 
erated at  the  power-house.  This  is  supplemented  by  gas 
supplied  from  the  city  gas-works,  for  use  in  cases  of  emer- 
gency and  for  ironing  in  the  laundry.  Thirteen  arc  lights 
at  different  points  about  the  place  illuminate  the  grounds 
in  the  evening. 

Water  is  now  supplied  from  the  city  water-works  at  an 
annual  rental  of  $500.  Considerable  expenditure  has  re- 
cently been  made  towards  obtaining  an  independent  supply 
by  means  of  deep  wells,  using  compressed  air  to  elevate  the 
water  to  a  storage  reservoir  on  the  hill  in  the  rear  of  the 
central  group  of  buildings.  It  is  believed  that  this  plan  will 
afford  an  ample  supply. 

Sewage  is  discharged  into  a  tributary  of  the  Ohio,  but 
against  the  protests  of  residents  and  local  boards  of  health. 
With  a  recent  appropriation  it  is  proposed  to  introduce 
an  elaborate  sewerage  system  for  the  entire  institution, 
except  the  insane  department,  upon  the  plan  adopted  at 
Brockton,  Massachusetts.  For  the  insane  department  an 
experiment  has  been  tried  of  a  new  adaptation  of  the  inter- 


OHIO  HOSPITAL  FOR  EPILEPTICS.  79 

mittent  filtration  principle,  of  which  Dr.  Rutter  says: 
"  This  has  proved  successful,  and  it  takes  care  of  the  sewage 
for  250  people  at  an  outlay  of  less  than  $1000.  We  are 
making  a  careful  analysis  of  the  outflow  for  publication." 

It  is  the  aim  of  the  Manager  to  have  the  patients  engaged 
at  some  industrial  occupation  so  far  as  is  consistent  with 
their  welfare.  Outdoor  employment,  however,  is  restricted 
by  the  limited  acreage  of  arable  and  productive  land.  The 
patients  have  assisted  in  the  improvement  of  the  grounds, 
and,  as  far  as  practicable,  they  are  employed  in  the  gardens 
and  in  the  care  of  the  lawn.  A  large  conservatory  for 
plants  has  been  made  by  their  labor.  The  kitchen,  dining- 
rooms,  store-rooms,  and  laundry  furnish  occupation  for  a 
considerable  number,  and  a  few  are  engaged  in  clerical  work 
in  the  offices  and  some  other  departments.  All  the  clothing 
for  female  patients  is  made  by  the  inmates,  and  the  making 
of  the  mattresses,  comforters,  sheets,  and  pillows  is  also  the 
work  of  their  hands.  Other  industries  include  bookbind- 
ing, the  making  of  splint  baskets,  the  upholstering  of  furni- 
ture, and  the  repairing  of  shoes.  Arrangements  will  soon 
be  made  for  the  manufacture  of  brooms,  brushes,  shoes, 
willow  baskets,  and  all  the  clothing  for  the  men  and  boys. 
The  plant  for  manufacturing  ice  has  a  capacity  of  eighteen 
tons  daily.  The  low  price  of  bituminous  coal,  which  is  fur- 
nished from  a  side-track  of  the  railway  at  a  cost  of  from 
$1.05  to  $1.15  a  ton,  enables  the  institution  to  manufacture 
this  commodity  at  a  comparatively  small  expense. 

It  is  intended  to  establish  a  manual-training  school,  in 
which  the  young  may  be  taught  useful  trades  and  where 
adults  may  be  occupied  to  advantage.  It  is  also  expected 
that  a  brickyard  and  joiner's  shops  will  in  the  near  future 
prove  an  advantage  in  the  erection  of  new  buildings.  A 
dairy  farm  is  much  needed,  and  should  be  secured  if  suit- 


80  CARE  AND    TREATMENT  OF  EPILEPTICS. 

able  land  can  be  obtained  in  the  vicinity.  At  the  time  of 
my  visit,  125  gallons  of  milk  were  purchased  daily  at  twelve 
cents  a  gallon  for  the  use  of  the  patients.  The  caring  for 
a  dairy  that  would  supply  the  institution  with  milk  would 
afford  congenial  employment  to  a  large  number  of  patients. 

The  two  dining-halls  are  subdivided  into  rooms  to  permit 
of  the  following  classification :  a  room  for  officers,  one  for 
employees  and  a  better  class  of  patients,  and  one  for  a  less 
refined  class  of  patients.  The  children  are  separated  into 
three  classes  and  eat  at  separate  tables  in  the  rooms  with  the 
adults.  Each  table  accommodates  eight  persons.  Dr. 
Rutter  recommends  a  still  further  classification  of  patients 
into  separate  rooms.  The  patients  come  from  the  different 
buildings  to  the  dining-rooms  regardless  of  the  weather.  If 
it  rains  or  snows  umbrellas  are  carried. 

The  regulation  of  the  diet  is  regarded  as  one  of  the  most 
important  means  of  treating  epilepsy,  not  only  as  to  what 
the  patients  eat,  but  how  they  eat.  The  constant  tendency 
on  the  part  of  epileptics  is  to  eat  too  fast,  and  on  the  part 
of  attendants  to  hurry  meals  and  have  them  soon  over. 
Meals  are  therefore  served  in  three  courses,  and  no  food  is 
placed  upon  the  tables  at  any  time  until  all  are  seated. 
Steam-heated  tables  in  adjoining  rooms  keep  the  food  warm 
until  it  is  served.  Observation  and  experience  since  1893 
have  demonstrated  the  wisdom  of  allowing  a  free  meat  diet 
only  for  the  midday  meal.  Fresh  beef,  roasted  or  boiled, 
mutton,  fowls,  and  fish  enter  into  the  bill  of  fare.  No 
article  of  food  is  fried.  Fresh  fruit  is  freely  allowed  in  its 
season,  and  fruit  is  largely  used  in  canned  or  evaporated 
form  when  not  otherwise  obtainable.  It  is  liberally  supplied 
at  breakfast  and  supper,  and  is  supplemented  by  cereals 
and  milk.  Coffee  is  also  served  for  breakfast.  Bread  is 
not  used  until  thoroughly  cold.     Hot  corn-cake  is  occasion- 


■ 


RESIDENCE    FOR    75    FEMALE    PATIENTS.  LAUNDRY.  GIRLS'    SCHOOLHOUSE. 

OHIO    HOSPITAL    FOR    EPILEHllCS. 


OHIO    HOSPITAL    FOR    EPILEPTICS. 
DEPARTMENT    FOR    THE    INSANE. 


OHIO  HOSPITAL  FOR  EPILEPTICS.  8 1 

ally  allowed.  Certain  vegetables,  such  as  cabbages  and 
cucumbers,  denied  epileptics  by  some  superintendents,  are 
not  regarded  as  objectionable  at  the  Ohio  Hospital.  The 
daily  record  of  attacks  and  the  daily  record  of  the  dietary 
are  carefully  compared  and  afford  a  profitable  study. 

The  daily  routine  is  as  follows:  The  patients  are  called  at 
5.30  o'clock;  have  their  breakfast  at  6;  dinner  at  11.30; 
and  supper  at  5.  They  retire  at  8  o'clock  in  winter  and  at 
8.30  in  summer. 

The  social  influences  of  the  colony  are  found  to  affect 
even  the  most  degraded,  especially  among  the  younger 
patients.  The  prayer-meetings  in  the  different  houses  and 
the  regular  religious  services  in  the  chapel,  the  Sabbath- 
school,  and  the  entertainments  in  the  amusement  hall  have 
been  potent  factors  for  good.  An  effort  is  made  to  afford 
the  patients  as  large  opportunities  for  social,  moral,  and  re- 
ligious improvement  as  are  open  to  people  in  the  ordinary 
walks  of  life. 

A  summer  picnic  is  one  of  the  enjoyable  occasions  of  the 
year,  which  is  looked  forward  to  with  much  interest.  Last 
year  the  preparations  in  the  domestic  department  included 
the  cooking  of  250  chickens,  baking  quantities  of  plain  cake, 
etc.,  and  the  making  of  copious  supplies  of  ice-cream  and 
lemonade.  The  party  was  accompanied  by  a  band.  A 
special  train  was  provided,  and  all  were  taken  to  a  pleasant 
locality  some  sixty  miles  away.  A  short  time  previous  to 
my  visit  between  500  and  600  patients  were  taken  to  Fore- 
paugh's  circus  without  any  accident  or  embarrassment. 

A  large  stereopticon  having  one  thousand  different  views 
is  a  frequent  means  of  evening  entertainment.  Brief  lectures 
accompany  the  display  of  the  pictures.  There  are  baseball 
teams  which  compete  creditably  with  teams  of  neighboring 
localities.     For  the  women  lawn-tennis  and  croquet  grounds 

6 


82  CARE  AND    TREATMENT  OF  EPILEPTICS. 

are  provided.  For  indoors  they  have  all  ordinary  games, 
such  as  checkers,  backgammon,  dominoes,  and  cards.  A 
limited  collection  of  entertaining  books  is  supplied.  A  few 
popular  magazines  and  some  newspapers  are  contributed. 
In  respect  to  desirable  reading  matter  there  appeared  to  be 
a  marked  deficiency. 

It  was  my  pleasure  to  be  present  at  one  of  the  evening 
entertainments  in  the  assembly-hall,  which  was  brilliantly 
lighted  and  tastefully  decorated.  There  were  gathered  about 
two  hundred  patients  of  both  sexes,  among  whom  was  a  fair 
proportion  of  boys  and  girls — all  under  the  charge  of  about 
thirty  male  and  female  attendants.  The  patients  were 
neatly  and  tidily  dressed.  The  male  attendants  were  attired 
in  the  customary  gray  cloth  uniforms  trimmed  with  black 
braid ;  the  female  attendants  also  wore  the  regulation  dress 
of  gray  trimmed  with  black,  with  white  collars  and  white 
aprons.  There  were  a  few  citizens  from  Gallipolis  in 
attendance.  An  orchestra  composed  of  patients  rendered 
pleasing  music  from  the  bass  viol,  violins,  wind  instruments, 
and  the  piano.  In  addition  to  popular  dances,  there  were 
marching  and  counter-marching  in  shifting  lines  and  col- 
umns. The  various  changes  were  called  off  by  one  of  the 
supervisors.     The  occasion  was  a  very  pleasant  one. 

The  day-schools  for  both  sexes  have  one  male  and  one 
female  teacher.  The  children  are  taught  according  to  their 
capacity  for  the  reception  of  knowledge,  either  by  means  of 
kindergarten  methods,  embracing  the  ordinary  object-lesson 
system  of  teaching,  or  by  the  common-school  methods  of  in- 
struction in  reading,  writing,  drawing,  arithmetic,  and  lan- 
guage lessons.  They  are  not  pushed  in  any  of  these  studies 
beyond  what  is  considered  prudent  and  proper.  It  is  as- 
serted that  there  is  a  constant  improvement  in  the  mental, 
moral,  and  physical  condition  of  the  children. 


OHIO  HOSPITAL  FOR  EPILEPTICS.  83 

In  a  pleasant  sub-parlor  of  one  of  the  men's  pavilions  I 
saw  one  of  the  patients,  an  intelligent-looking  man,  engaged 
in  teaching  vocal  music  to  a  class  of  nine  patients.  All  had 
books  in  their  hands  and  appeared  to  be  absorbed  in  their 
lesson. 

Large  opportunities  are  given  for  devotional  exercises 
according  to  the  belief  of  the  individual.  A  service  is  held 
every  Sunday  afternoon,  which  is  conducted  by  pastors  from 
the  city,  those  of  different  denominations  serving  in  succes- 
sion.    A  Catholic  priest  says  mass  at  stated  intervals. 

The  school-teacher  conducts  a  Sabbath-school  in  which 
song  service  predominates.  Between  200  and  300  per- 
sons, both  children  and  adults,  usually  participate  in  the 
service. 

Prayer-meetings  are  held  twice  a  week  in  some  one  of  the 
pavilions  that  can  be  set  apart  for  the  purpose.  These  are 
conducted  by  clergymen  patients,  among  whom  are  Metho- 
dists, Baptists,  Christians,  and  those  of  other  denominations. 
Attendance  is  entirely  voluntary.  Controversies  are  for- 
bidden, and  difficulties  seldom  attend  the  holding  of  these 
meetings.  They  run  along,  Dr.  Rutter  said,  quite  smoothly 
for  perhaps  several  months,  when  there  may  be  a  demon- 
stration of  some  kind.  At  one  time  a  discussion  between  a 
Baptist  and  a  Methodist  ended  in  a  fight.  An  encounter 
may  occur  at  any  time  between  two  persons  who  are  on  the 
most  friendly  footing  about  so  slight  a  matter  as  the  weather, 
one  asserting,  for  instance,  that  the  appearance  of  the  clouds 
indicates  rain,  the  other  denying  the  assertion  as  absurd, 
and  the  controversy  running  into  a  question  of  veracity  as 
to  what  one  or  the  other  had  said,  and  ending  in  a  personal 
conflict. 

Dr.  Rutter  said  that  the  difficulties  experienced  at  the 
outset   in    harmonizing   the    discordant    elements    brought 


84  CARE  AND    TREATMENT  OF  EPILEPTICS. 

together  here  from  all  ranks  of  life  were  very  great.  Two 
hundred  and  fifty  epileptics — some  from  family  homes, 
where  selfishness  had  been  developed  by  the  indulgence  of 
every  whim ;  some  from  almshouses,  where  discipline  is 
often  lax — were  brought  together  with  the  expectation  on 
the  part  of  friends  that  the  condition  of  all  would  be  im- 
proved and  that  some  would  be  cured.  The  task  was  a 
severe  tax  upon  human  ingenuity  and  patience,  and  there 
was  no  similar  institution  in  this  country  to  which  one  could 
look  for  sympathy  and  counsel.  But  with  the  development 
of  the  hospital  and  larger  means  for  classification,  the  pa- 
tients improved ;  and  the  results  of  the  efforts  put  forth  are 
gratifying  to  the  management.  The  number  of  quarrels  is 
said  to  be  less  now  than  it  was  with  the  first  fifty  patients. 

Discipline  is  maintained  by  restricting  the  privileges  of 
the  patients  and  by  personal  appeals  to  their  higher  natures. 
An  appeal  to  their  sympathy  in  behalf  of  one  afflicted  like 
themselves  and  entitled  to  forbearance  is  frequently  most 
effective.  No  physical  punishment  is  permitted  under  any 
circumstances.  When  patients  become  dangerous  and  de- 
structive, they  are  placed  in  a  room  alone,  but  are  brought 
out  as  soon  as  they  seem  to  be  able  to  control  themselves. 
One  of  the  lady  supervisors,  who  had  had  six  years'  experi- 
ence in  the  Toledo  Asylum  for  the  Insane,  told  me  she  had 
found  that  epileptics  were  much  more  difficult  to  get  along 
with  than  the  insane.  The  Superintendent  complains  that, 
from  a  lack  of  laws  prohibiting  the  sale  of  intoxicating 
liquors  within  a  prescribed  distance  of  the  institution,  his 
efforts  to  benefit  his  patients  are  in  some  degree  neutralized. 

Attendants  are  not  specially  trained  before  entering  the 
asylum.  As  good,  intelligent,  and  reliable  men  and  women 
as  can  be  found,  having  tact,  patience,  and  orderly  habits, 
are  selected.     In  the  infirmaries  there  are  five  attendants 


OHIO  HOSPITAL   FOR  EPILEPTICS.  85 

to  each  group  of  seventy-six  patients.  At  night  there  are 
on  duty  one  general  supervisor  for  the  women  and  one  for 
the  men,  each  of  whom  is  assisted  by  five  night-watchers. 
In  the  insane  asylum  there  are  one  physician,  a  matron,  and 
two  head  attendants  —  one  male  and  one  female  —  who 
assume  direction  over  the  subordinate  force.  There  is  on 
an  average  one  attendant  to  thirteen  insane  patients.  In 
the  other  buildings  there  is  usually  one  attendant  to  about 
eighteen  epileptics,  although  in  some  of  the  wards  there  is 
but  one  to  twenty-five  patients.  Male  attendants  are  paid 
from  $25  to  $30  a  month,  according  to  their  intrinsic  worth 
and  the  duties  they  discharge.  Women  attendants  are 
paid  from  $18  to  $20  on  the  same  basis. 

The  number  of  admissions  to  the  hospital  from  its  open- 
ing in  1893  to  November  30,  1898,  was  1295,  eight  of  which 
were  readmissions.  Of  the  patients  received  during  the 
period  named,  1217  were  born  in  the  United  States,  33  in 
Germany,  10  in  England,  8  in  Ireland,  5  in  Switzerland,  and 
8  in  other  countries.  The  nativity  of  14  was  unknown. 
While  1002  of  the  patients  admitted  were  subject  to  epi- 
leptic seizures  before  they  were  twenty  years  old,  758  had 
passed  that  age  before  they  were  received  into  the  hospital. 
Of  the  latter  number  153  were  married,  29  were  widowed, 
11  had  been  divorced,  and  565  had  never  been  married.  The 
number  discharged  as  recovered  during  the  period  named 
was  81,  as  improved  180,  unimproved  104.  There  were  108 
deaths.  Patients  are  not  considered  recovered  until  two 
years  have  elapsed  after  their  last  seizure.  At  the  date  of 
April  1,  1899,  there  were  898  patients  in  the  hospital — 458 
males  and  440  females.  Thirty-eight  of  the  inmates  were 
boys  and  67  were  girls  under  ten  years  of  age,  and  182  were 
boys  and  154  were  girls  under  twenty  years  of  age.  The 
capacity  of  the  institution  is  for  900  patients. 


86  CARE  AND    TREATMENT  OF  EPILEPTICS. 

The  per  capita  annual  cost  of  maintenance  as  given  April 
I,  1899,  was  $128.52,  which  includes  the  total  current  ex- 
penses and  officers'  salaries.  The  value  of  the  supplies  raised 
upon  the  farm  is  not  considered  in  computing  the  cost  of 
maintenance. 

There  is  a  continual  demand  for  admission.  The  applica- 
tions now  on  file  number  upwards  of  1300.  Many  of  the 
applicants,  it  was  said,  were  inmates  of  the  poorhouses,  and 
many  belonged  to  the  needy  classes  who  have  no  adequate 
means  of  support,  and  are  not  only  burdens,  but  a  cause  for 
apprehension,  to  the  communities  in  which  they  reside. 

Considering  the  peculiar  idiosyncrasies  of  epileptics,  there 
appeared  to  be  about  this  institution  an  air  of  quietness  and 
contentment  that  was  gratifying  to  witness.  This  I  at- 
tributed in  a  great  degree  to  the  demeanor  of  the  Superin- 
tendent, who  moved  about  among  his  patients  as  a  kind 
father  among  his  children.  There  was  freedom  without 
familiarity,  gentleness  without  weakness.  All  questions 
put  to  him  were  properly  answered,  and  there  was  an  evi- 
dence of  satisfaction  attending  his  replies  that  betokened 
confidence.  Dr.  Rutter  said:  "  I  make  it  an  invariable  rule 
to  listen  to  any  complaint  that  may  be  made  to  me,  and  to 
show  personal  interest  in  the  affairs  of  all  patients,  no  mat- 
ter how  trivial  they  may  seem  to  be,  or  how  much  my  time 
may  be  needed  for  other  purposes.  They  are  all  taught  to 
feel  that  they  can  come  to  me  at  any  time  with  any  com- 
plaint and  receive  kind  and  attentive  consideration."  The 
attendants,  as  is  usually  the  case,  manifested  the  same 
disposition  as  the  master  spirit  of  the  place,  and  defer- 
ence and  consideration  were  shown  instead  of  coldness  and 
unconcern.  Dr.  Rutter  is  deeply  interested  in  his  work, 
believing  that  the  greatest  of  all  psychological  fields  is  the 
study  of  epilepsy. 


CHAPTER   III. 
NEW  YORK. 

THE  State  Commissioner  in  Lunacy  for  New  York, 
Dr.  John  Ordronaux,  in  his  First  Report,  presented 
to  the  Legislature  in  1874,  recommended  the  establishment 
of  a  State  hospital  for  epileptics,  and  dealt  with  the  subject 
in  the  following  language: 

"  Statistics  show  that  there  are  at  present,  in  the  various 
lunatic  asylums  and  almshouses  of  our  State,  436  epileptics, 
of  whom  245  are  males  and  191  females.  The  majority  of 
these  receive  no  medical  treatment  whatever,  their  disease 
being  looked  upon  as  a  simple  periodical  aberration  of  the 
functions  of  the  nervous  system,  terminating  in  a  fit. 
Hence  they  are  placed  promiscuously  among  the  young, 
the  sick,  and  the  susceptible,  without  reference  to  the  shock 
which  their  attacks  can  impart  to  others,  or  the  dangers 
of  violence  from  them  arising  at  such  times.  Physicians 
understand  well  enough  that  epilepsy  is  one  of  the  common 
ante-chambers  of  insanity,  and  the  statistics  of  crime  show 
that,  short  even  of  mental  unsoundness,  epileptics  suffer 
such  a  degeneration  of  their  moral  nature  that  they  cannot 
be  treated  as  enjoying  an  unclouded  moral  perception. 
They  are  always  standing,  therefore,  on  the  border-line  of 
disease,  and  present  the  most  difficult  problems  relating  to 
personal  responsibility  at  law. 

It  is  for  the  interest  of  the  State  to  prevent  crime,  no 
less  than  to  punish  it,  and  the  number  of  epileptics  now 

87 


88  CARE  AND    TREATMENT  OF  EPILEPTICS. 

within  our  county  asylums  points  to  the  existence  of  a 
source  of  crime  which  should  be  controlled,  as  well  in  the 
interests  of  justice  as  of  humanity.  The  time  has  fully 
come  when  a  State  hospital  for  epileptics  is  an  imperative 
necessity.  For,  even  apart  from  crime,  these  unfortunates 
need  special  medical  treatment  and  vigilance  such  as  they 
cannot  receive  in  county  almshouses.  Nor  are  they  prop- 
erly placed  in  lunatic  asylums,  where  their  own  disease  is  a 
source  of  disturbance  to  the  patients,  and  these,  in  turn,  an 
unfit  association  for  them." 

In  his  Second  Annual  Report  the  Commissioner  repeated 
the  recommendation,  and  continued  to  do  so,  urging  press- 
ing reasons  therefor,  in  his  Third,  Fourth,  Fifth,  Sixth, 
Seventh,  and  Eighth  Annual  Reports,  down  to  1882.  It 
is  not  a  matter  of  surprise  that  his  oft-repeated  recommend- 
ations, calling  for  another  State  institution,  were  not  acted 
upon,  in  view  of  the  vast  sums  the  State  was  then  expend- 
ing yearly  on  the  State  hospitals  for  the  insane, — several 
thousand  dollars  per  capita, — and  the  pressing  demand  for 
further  accommodation  for  this  class. 

The  State  Board  of  Charities,  in  its  Annual  Report  to  the 
Legislature  for  the  year  1878,  directed  attention  to  the  ne- 
cessity for  adopting  some  immediate  measures  of  relief  for 
epileptics  in  terms  as  follows  : 

The  subject  of  providing  for  the  care  and  treatment  of 
epileptics  has  long  attracted  wide  attention,  but  thus  far 
little  has  been  accomplished  regarding  the  matter,  either  in 
this  or  other  countries.  The  regulations  of  most  of  the  in- 
sane asylums  exclude  this  class  from  their  benefits,  yet  con- 
siderable numbers  of  them,  from  time  to  time,  under  various 
pretexts,  gain  admission  to  these  institutions.  That  epi- 
leptics need  intelligent  oversight  and  care,  equally  with  the 
insane,  both  on  account  of  their  helplessness  and  dangerous 


NEW    YORK.  89 

tendencies,  is  fully  and  very  generally  recognized.  The  dis- 
ease, although  not  offering  large  hopes  of  recovery,  is  subject 
to  the  influence  of  remedial  agencies;  and  it  would  appear 
to  be  wise  economy,  therefore,  suitably  to  provide  for  the 
treatment  of  this  class,  as  the  disease  early  destroys  the  ca- 
pacity for  self-maintenance,  and,  in  the  case  of  the  poor, 
soon  induces  pauperism.  The  hereditary  tendency  of  the 
disease  is  also  clearly  established,  and  it  would  seem  in- 
cumbent upon  the  State,  in  consequence,  to  institute  posi- 
tive measures  to  protect  society  against  its  increase." 

In  seeking  for  the  germs  of  the  movement  for  colonizing 
epileptics  in  this  country  we  must  look  in  another  direction. 
Dr.  Frederick  Peterson,  while  assistant  physician  of  the 
Hudson  River  State  Hospital  for  the  Insane,  had  a  con- 
siderable number  of  epileptics  under  his  charge  and  became 
specially  interested  in  the  treatment  of  this  class.  In  1886, 
in  pursuance  of  their  interests,  he  visited  the  colony  for 
epileptics  at  Bielefeld,  in  Westphalia,  of  which  little,  if 
anything,  was  then  known  in  this  country.  After  his  return 
home  he  wrote  a  full  description  of  this  peculiar  and  highly 
successful  work,  which  was  published  in  the  New  York 
Medical  Record 'in  April,  1887.  The  article  attracted  much 
attention  and  was  republished  in  England. 

Dr.  Peterson  in  his  zeal  continued  to  write  upon  this  sub- 
ject for  medical  and  other  journals,  and  his  whole-souled 
devotion  to  the  cause  he  had  espoused,  laid  broad  and  deep 
the  conviction  in  the  public  mind  that  a  State  colony  for 
epileptics  was  an  immediate  and  pressing  necessity.  He 
presented  the  subject  in  charity  conference  meetings,  at 
State  conventions  of  Superintendents  of  the  Poor,  and  else- 
where. He  also  urged  the  matter  upon  the  attention  of 
the  State  Charities  Aid  Association,  of  which  society  he 
was,  and  is  at  present,  a  member,  and  secured  its  influence 


9<D  CARE  AND    TREATMENT  OF  EPILEPTICS. 

and  co-operation.  A  sub-committee,  consisting  of  Dr. 
Peterson  and  Dr.  George  W.  Jacoby,  was  appointed  to  re- 
port to  the  Association  on  the  subject  of  State  provision  for 
epileptics.  The  following  views  were  expressed  in  the  able 
report  made  by  this  committee : 

"  That  hospitalization  is  impracticable  is  the  opinion  of 
all  who  have  investigated  the  subject.  Those  epileptics  who 
are  only  slightly  affected  by  their  disease  will  not  remain  in 
a  hospital  without  occupation  and  systematic  employment, 
and  those  who  are  severe  sufferers  with  marked  mental 
affection  cannot  be  kept  there.  Even  the  care  of  simple 
epileptics  without  any  insanity  differs  greatly  from  that  of 
any  other  class  of  patients,  and  their  treatment  in  any  hospi- 
tal is  a  difficult  matter.  With  the  organization  of  epileptic 
wards  in  general  asylums  matters  are  in  the  same  unsatis- 
factory condition.  The  plea  of  certain  supporters  of  the 
asylum  system,  that  every  epileptic  should  be  legally  placed 
in  confinement,  because  he  is  either  insane  or  may  become 
so  eventually,  is  a  plea  which  is  contrary  to  every  principle 
of  right  and  wrong.  If  a  hospital  for  epileptics  were  consoli- 
dated under  one  management  with  an  asylum,  it  would  be 
necessary  to  make  a  distinction  between  temporarily  men- 
tally deranged  epileptics  and  purely  convulsive  ones,  a  dis- 
tinction which  is  decidedly  artificial,  as  thus  the  temporarily 
mentally  disordered  epileptic  would  be  constantly  trans- 
ferred from  hospital  to  asylum  and  from  asylum  to  hospital. 
On  the  other  hand,  the  entire  question  can  be  solved  by  the 
creation  of  colonies,  the  admission  to  which  is  not  to  be 
regulated  by  the  mental  condition  of  the  patient,  but  in 
which,  after  admission,  a  classification  could  be  made  of 
those  afflicted  with  severe  mental  defects,  of  those  who  are 
able  to  work,  and  of  those  requiring  education.  Further 
classification,  according  to  general  aptitude,   frequency  of 


NEW    YORK.  91 

attack,  temperament,  and  educational  status,  would,  of 
course,  be  advisable." 

During  the  legislative  session  of  1890,  Dr.  Peterson  caused 
to  be  introduced  in  the  Legislature  a  bill  providing  for  the 
selection  of  a  site  for  a  colony  for  epileptics.  With  his  con- 
sent, a  bill  of  like  purport  was  afterwards  substituted  for  his 
by  the  State  Charities  Aid  Association.  It  failed,  how- 
ever, to  become  a  law. 

In  1892,  a  bill  was  introduced  in  the  Legislature,  by  request 
of  the  State  Charities  Aid  Association,  directing  the  com- 
missioners of  the  State  Board  of  Charities  to  select  a  suit- 
able site  whereon  to  establish  an  institution  on  the  colony 
plan  for  the  medical  treatment,  care,  education,  and  em- 
ployment of  epileptics.  The  commissioners  were  authorized 
to  contract  for  the  purchase  of  such  a  site,  conditioned  upon 
the  approval  of  the  Legislature,  and  to  report  plans  and 
estimates  of  cost  of  constructing  buildings  suitable  for  the 
purpose.  The  proposed  legislation,  in  addition  to  the  in- 
fluence of  the  State  Charities  Aid  Association,  had  the 
support  of  the  State  Board  of  Charities,  as  also  of  the  Su- 
perintendents of  the  Poor,  who,  at  a  State  convention  in 
1891,  adopted  a  preamble  and  resolution  setting  forth  the 
fact  that  proper  facilities  for  the  care,  treatment,  and  em- 
ployment of  epileptics  in  the  county  poorhouses  and  town 
and  city  almshouses  did  not  exist,  and  recommending  the 
establishment  of  a  State  institution  for  this  class. 

The  State  Commission  in  Lunacy  in  its  Third  Annual  Re- 
port, submitted  to  the  Legislature  February  15,  1892,  recom- 
mended separate  care  for  epileptics  in  the  following  terms : 

"  There  can  be  no  question  as  to  the  desirability  of  the 
State  making  special  provision  for  epileptics  of  the  depend- 
ent and  semi-dependent  class,  apart  from  the  insane.  The 
practice  which  now  obtains  of  confining  epileptics  proper  in 


92  CARE  AND    TREATMENT  OF  EPILEPTICS. 

hospitals  for  the  insane,  as  insane  persons  and  commingled 
with  the  insane,  is  an  injustice  to  both  classes,  and  one 
which,  in  the  opinion  of  the  Commission,  the  State  should 
take  early  steps  to  remove  by  the  establishment  of  a  State 
hospital  especially  devoted  to  the  custody,  care,  and  treat- 
ment of  epileptics." 

The  measure  was  also  approved  by  many  of  the  super- 
intendents of  insane  asylums,  leading  physicians,  and  the 
press  throughout  the  State.  The  bill  passed  both  Houses 
of  the  Legislature,  was  approved  by  the  Governor,  and  be- 
came a  law  May  12,  1892. 

Soon  after  the  passage  of  the  act  a  committee  was  ap- 
pointed by  the  State  Board  of  Charities,  consisting  of  Presi- 
dent Craig  and  Commissioners  Letchworth  and  Walrath, 
who  were  charged  with  the  duty  of  inspecting  sites,  ex- 
amining plans,  and  ascertaining  facts  relative  and  important 
to  the  object  of  the  statute,  namely,  the  establishment  in  a 
proper  situation,  with  a  proper  organization,  of  a  colony  for 
epileptics.  The  committee  soon  after  its  appointment  issued 
a  circular  addressed  to  Senators,  members  of  Assembly,  jus- 
tices of  the  Supreme  Court,  and  clerks  of  Boards  of  Super- 
visors, representing  all  the  counties  in  which  it  would  appear 
that  a  colony  might  be  advantageously  established,  inviting 
suggestions  for  proper  sites,  with  full  particulars  as  to 
market  values  of  land,  proximity  to  town,  etc.,  and  pre- 
senting the  following  points  as  essential  to  be  considered  in 
the  selection  of  a  site: 

"  1.  A  tract  of  good  land,  including  not  less  than  one 
thousand  acres,  and  embracing  numerous  situations  for  a 
colony  or  village  of  small  shops  and  residences,  with  one  or 
more  larger  buildings  for  hospital  and  administration  uses, 
to  accommodate  a  population  of  from  one  thousand  to  two 
thousand  patients. 


NEW    YORK.  93 

"  2.  A  healthy  location,  with  climate  inviting  outdoor 
work  and  life,  and  pleasant  scenery. 

"  3.  A  sufficient  supply  of  pure  water  for  distribution 
throughout  the  buildings  by  gravity. 

"  4.  Facilities  for  the  easy  and  final  disposal  of  all  sewage, 
without  danger  of  polluting  waters  that  are  used  for  drink- 
ing purposes ;  and  for  good  surface  drainage,  with  freedom 
from  secret  springs  and  sub-moisture. 

"  5.  Railway  communication  for  passengers  and  freight, 
with  advantages  for  side-track  or  switch  to  the  grounds." 

A  large  part  of  the  summer  of  1892  was  taken  up  by 
members  of  the  committee,  either  collectively  or  separately, 
in  examining  sites  and  collecting  information  bearing  upon 
the  subject.  The  committee  found  that  the  centre  of  the 
epileptic  population  of  the  State  was  in  its  southeastern 
portion,  and  would  have  preferred  to  locate  the  colony 
there  had  circumstances  warranted,  but  the  mountainous 
character  of  the  country  and  other  objections  rendered  it 
impracticable.  The  superiority  of  a  site  at  Sonyea,  in  Liv- 
ingston County,  offered  by  the  United  Society  of  Christian 
Believers  (commonly  called  Shakers)  was  so  manifest  that 
the  committee  were  predisposed  in  its  favor.  It  consisted 
of  a  large  tract  of  land  upon  which  were  numerous  build- 
ings that  had  been  erected  by  the  Shakers  for  the  pur- 
poses of  the  community,  and  presented  in  their  arrangement 
and  relation  to  one  another  the  aspects  of  a  colony.  One 
of  the  original  purposes  of  the  Society  was  to  receive  and 
maintain  orphan  children,  some  of  whom  would  take  the 
place  of  deceased  members ;  but  the  multiplication  of  insti- 
tutions for  homeless  children  in  Western  New  York  stood 
in  the  way  of  thus  increasing  their  numbers,  which  their 
practice  of  celibacy  also  restricted.  The  members  were 
mostly   advanced    in    years,    and    as   their    numbers   were 


94  CARE  AND    TREATMENT  OF  EPILEPTICS. 

gradually  but  surely  diminishing,  they  decided  to  sell  their 
home  at  Sonyea  and  unite  their  fortunes  with  a  similar  so- 
ciety at  Watervliet,  N.  Y.  The  earnest  and  expressed  desire 
of  the  Shakers  was  to  have  the  Sonyea  property  dedicated  to 
some  charitable  work.  Believing  that  their  own  work  was  of 
this  nature,  they  desired  that  a  benevolent  purpose  might 
be  perpetuated  in  connection  with  the  estate.  For  this  reason 
they  preferred  not  to  sell  it  out  in  parcels,  which  they  could 
have  done  at  greater  pecuniary  advantage.  The  committee 
concluded  that  the  purchase  of  the  property  was  desirable 
and  so  reported  to  the  Board,  with  plans  and  estimates  for 
improvements,  which  were  endorsed  by  the  Board  and  for- 
warded to  the  Legislature  with  recommendations  in  a  full 
report  upon  the  subject,  including  maps,  surveys  of  engineers, 
affidavit  as  to  healthfulness  of  site,  chemical  analysis  of  the 
water,  photographs  of  buildings,  etc.,  all  of  which  had  been 
collected  and  prepared  under  the  direction  of  the  committee. 
In  the  performance  of  its  duties  the  committee  invited  the 
co-operation  of  Dr.  Peterson,  who  rendered  it  valuable  gra- 
tuitous assistance. 

In  1893,  a  bill,  prepared  by  the  State  Charities  Aid  Asso- 
ciation, substantially  in  conformity  with  the  recommenda- 
tions and  report  of  the  State  Board  of  Charities,  was 
introduced  in  the  Legislature  by  request  of  the  Association. 
It  passed  both  Senate  and  Assembly,  but  was  vetoed  by 
Governor  Flower.  In  his  memorandum  concerning  it  he 
declared  it  to  be  a  worthy  movement,  but  objected  to 
sanctioning  it  on  account  of  heavy  demands  upon  the  State 
treasury  for  the  support  of  the  insane,  and  because  he  did 
not  approve  of  its  provisions  relating  to  the  government  of 
the  colony. 

The  veto  of  the  bill  was  a  severe  disappointment  to  a 
great  number  of  philanthropists  and  scientists  throughout 


NEW    YORK.  95 

the  State,  who  saw  in  its  provisions  the  fruition  of  long  and 
weary  efforts,  and  who  felt  that  the  broad  and  fertile  domain 
at  Sonyea  would  be  an  acquisition  of  incalculable  value  to 
the  State. 

The  securing  of  the  property  by  legislation  now  seemed 
like  a  futile  effort,  and  no  further  movement  was  made  in 
the  matter  until  near  the  close  of  1893,  when  a  new  option 
of  purchase  was  obtained  from  the  Shaker  community  by 
Mr.  H.  E.  Brown.  At  the  request  of  Governor  Flower,  Dr. 
Peterson  and  the  writer  held  a  special  conference  with  the 
Governor,  and  modifications  in  the  bill  of  1893  were  agreed 
upon  and  concurred  in  by  the  State  Charities  Aid  Associa- 
tion, and  the  bill  was  presented  to  the  Legislature  by  the 
Association.  This  bill,  largely  through  the  efforts  and  sym- 
pathy created  for  it  by  the  State  Charities  Aid  Association, 
and  the  education  of  the  people  by  the  press,  passed  both 
Houses  of  the  Legislature,  the  vote  in  the  Senate  being 
unanimous  in  its  favor.  The  act  was  approved  by  the 
Governor  April  25,  1894. 

In  January  of  this  year,  Oscar  Craig,  President  of  the 
State  Board  of  Charities,  died  greatly  lamented.  Although 
having  a  large  and  lucrative  practice,  he  set  it  almost  en- 
tirely aside  in  voluntary  service  to  the  State  Board.  His 
legal  ability  was  of  a  high  order,  and  his  benevolence  was 
unbounded.  In  consideration  of  his  distinguished  services 
to  the  State,  at  the  suggestion  of  Governor  Flower,  the 
colony  was  designated  in  the  bill  as  the  Craig  Colony. 

The  bill  appropriated  $115,000  for  the  purchase  of  the 
Sonyea  property,  and  provided  that  the  design  for  the  im- 
provement and  development  of  the  colony  should  be  ap- 
proved by  the  State  Board  of  Charities. 

The  act  to  organize  and  establish  a  colony  for  epileptics — 
Chapter  363,  Laws  of  1894 — is  drawn  in  substantially  the 


96  CARE  AND    TREATMENT  OF  EPILEPTICS. 

same  form  as  the  organizing  acts  establishing  the  New  York 
State  hospitals  for  the  insane,  except  as  to  modifications  nec- 
essary to  adapt  the  institution  to  the  reception,  care,  and 
treatment  of  epileptics.  The  act  sets  forth  the  objects  of  the 
colony  and  the  principles  upon  which  it  is  founded  as  follows : 

"  The  objects  of  such  colony  shall  be  to  secure  the  hu- 
mane, curative,  scientific,  and  economical  treatment  and 
care  of  epileptics,  exclusive  of  insane  epileptics,  to  fulfil 
which  design  there  shall  be  provided,  among  other  things,  a 
tract  of  fertile  and  productive  land,  in  a  healthful  situation, 
and  an  abundant  supply  of  wholesome  water,  sufficient 
means  for  drainage  and  disposal  of  sewage,  and  sanitary  con- 
ditions; and  there  shall  be  furnished,  among  other  necessary 
structures,  cottages  for  dormitory  and  domiciliary  uses, 
buildings  for  an  infirmary,  a  schoolhouse,  and  a  chapel, 
workshops  for  the  proper  teaching  and  productive  prosecu- 
tion of  trades  and  industries;  all  of  which  structures  shall 
be  substantial  and  attractive,  but  plain  and  moderate  in  cost, 
and  arranged  on  the  colony  or  village  plan." 

An  amendatory  act  provides  that  there  shall  be  a  board 
of  twelve  unsalaried  managers,  appointed  by  the  Governor 
for  terms  of  three  years  each  and  confirmed  by  the  Senate. 
Each  of  the  eight  judicial  districts  of  the  State  is  entitled  to 
a  representative  on  the  Board ;  and  the  seventh  district,  in 
which  the  colony  is  situated,  and  the  fifth,  sixth,  and  eighth 
districts,  have  each  an  additional  member. 

Provision  is  made  for  the  appointment  by  the  Board  of 
Managers  of  a  superintendent,  who  shall  be  "a  well-educated 
physician  and  a  graduate  of  a  legally  chartered  medical  col- 
lege, with  an  experience  of  at  least  five  years  in  the  actual 
practice  of  his  profession,  including  one  year's  actual  ex- 
perience in  a  general  hospital,  and  who  shall  be  certified  as 
qualified  by  the  Civil  Service  Commission  after  a  competitive 


NEW    YORK.  97 

examination."  The  act  also  provides  for  the  appointment 
of  a  treasurer  by  the  managers  outside  of  their  own  number. 
These  officers  hold  their  appointments  subject  to  discharge 
or  suspension  in  the  discretion  of  the  Board.  The  stew- 
ard, matron,  bookkeeper,  teachers,  attendants,  assistants, 
and  other  subordinates  are  appointed  by  the  Superintend- 
ent, who  prescribes  their  duties  and  places,  and,  subject  to 
the  approval  of  the  Board  of  Managers,  determines  their 
compensation.  The  Superintendent,  subject  to  the  Board 
of  Managers,  is  required  to  "  maintain  salutary  discipline 
among  all  employees,  patients,  and  inhabitants  of  the 
colony,  and  enforce  strict  compliance  with  his  instructions 
and  uniform  obedience  to  all  the  rules  and  regulations  of 
the  colony."  It  is  required  that  the  Treasurer  shall  deposit 
all  moneys  received  for  the  care  of  patients,  and  all  other 
revenues,  in  a  bank  designated  by  the  Comptroller,  and 
make  regular  reports  to  him.  The  Board  of  Managers  is 
required  to  report  annually  to  the  State  Board  of  Charities. 
In  the  admission  of  patients,  the  act  establishing  the  col- 
ony provides  that  there  shall  be  received  and  gratuitously 
supported  in  the  colony  epileptics  residing  in  the  State  who 
are  unable  either  of  themselves  or  through  their  parents  or 
guardians  to  provide  for  their  support  therein ;  that  prefer- 
ence shall  always  be  given  to  poor  or  indigent  epileptics 
over  all  others ;  and  that  those  able  to  support  themselves 
only  in  part  shall  take  precedence  over  those  wholly  able  to 
support  themselves.  Whenever  an  epileptic  becomes  a 
charge  upon  the  public  it  is  made  the  duty  of  the  poor 
authorities  responsible  for  his  care  to  place  him  in  the 
colony.  Such  authorities  are  also  required  to  furnish 
annually  to  the  State  Board  of  Charities  a  list  of  all  the 
epileptics  in  their  jurisdiction,  with  such  particulars  as  to 
their  condition  as  shall  be  required  by  the  Board.     It  is 


98  CARE   AND    TREATMENT   OF  EPILEPTICS. 

provided  that  the  annual  per  capita  allowance  to  the  Board 
of  Managers  for  board,  lodging,  medical  treatment,  care,  and 
tuition  of  State  patients  shall  not  exceed  $250.  Each  State 
patient,  while  in  the  colony,  is  entitled  to  receive  annually 
from  the  Board  of  Supervisors  of  his  county  the  sum  of  $30 
for  clothing.  The  colony  is  required  to  keep  an  itemized 
account  of  all  articles  of  clothing  furnished  patients,  and 
send  a  bill  for  same  to  the  county  authorities  of  each  county 
on  the  first  day  of  October  of  each  year.  It  is  a  rule  of  the 
colony  to  send  to  the  friends  or  relatives  of  the  patient  a 
notice,  on  the  admission  of  each  patient,  asking  whether 
such  friends  or  relatives  prefer  to  furnish  clothing  for  the 
patient  or  whether  the  same  is  to  be  furnished  by  the  State. 
This  is  done  in  order  that  those  desiring  to  provide  a  better 
quality  of  clothing  than  that  furnished  by  the  State  may 
have  the  opportunity  of  doing  so. 

In  the  reception  of  epileptic  children  as  State  patients, 
the  statement  of  particulars  accompanying  each  application 
must  be  verified  by  the  affidavits  of  the  petitioners  and  of 
two  disinterested  persons,  and  accompanied  by  the  opinion 
of  a  qualified  physician,  all  of  whom  must  be  certified  to  be 
credible  by  the  county  judge  or  surrogate  of  the  county, 
who  must  also  certify  that  the  patient  is  a  proper  candidate 
for  admission  to  the  colony.  An  epileptic  child  not  coming 
under  the  designation  of  State  patient  may  be  placed  in  the 
colony  by  the  poor  authorities  upon  the  application  of  a 
parent,  guardian,  or  friend,  with  satisfactory  proof  that  the 
health,  morals,  comfort,  and  welfare  of  such  child  may  be 
endangered  if  it  is  not  placed  in  the  colony,  provided  the 
expense  of  the  care  of  the  child  is  met  by  the  Board  of 
Supervisors,  which  is  authorized  to  recover  the  cost  of 
maintenance  from  the  parents  or  guardians. 

Whenever  applications  are   made   for  the  admission  of 


NEW    YORK.  99 

more  State  patients  than  can  be  properly  accommodated  in 
the  colony,  the  managers  are  required  to  apportion  the 
number  received  so  that  each  county  may  be  represented  in 
the  ratio  of  its  dependent  epileptics  to  the  dependent  epi- 
leptic population  of  the  State,  as  shown  by  statistics  fur- 
nished by  the  State  Board  of  Charities.  When  the  capacity 
of  the  institution  will  permit,  private  patients  may  be  ad- 
mitted into  the  colony  on  terms  prescribed  by  the  Superin- 
tendent and  approved  by  the  managers. 

Patients  may  be  discharged  from  the  colony  by  the  Super- 
intendent, with  the  approval  of  the  managers;  but  in  no 
instance  is  it  lawful  to  return  a  patient  to  the  poorhouse, 
either  directly  through  a  superintendent  of  the  poor  or 
otherwise.  If  a  State  patient  becomes  insane  while  an  in- 
mate of  the  colony  he  must  be  sent  to  the  State  hospital  of 
the  district  of  which  he  was  a  resident  just  prior  to  his  ad- 
mission to  the  colony.  His  transfer  must  be  effected  in  a 
manner  prescribed  by  the  State  Commission  in  Lunacy,  at 
the  expense  of  the  State ;  and  the  institution  to  which  he 
is  sent  may  be  required,  under  regulations  made  by  the 
Commission,  to  send  a  trained  attendant  to  accompany  the 
patient  to  the  hospital.  For  every  female  patient  thus 
transferred  there  shall  be  provided  a  female  attendant.  In 
case  the  friends  of  an  insane  patient  desire  his  removal  to  a 
State  hospital  other  than  the  one  in  the  district  of  which  he 
was  a  resident  previous  to  his  admission  to  the  colony,  such 
wish  shall  be  granted  provided  there  be  sufficient  accommo- 
dation in  such  hospital  for  his  reception.  A  private  patient 
who  becomes  insane  is  committed,  subject  to  the  regula- 
tions of  the  State  Commission  in  Lunacy,  to  such  institu- 
tion for  the  insane  as  may  be  designated  by  such  patient, 
his  relatives,  or  friends,  all  expenses  incident  to  the  removal 
being  paid  by  them. 


IOO  CARE  AND    TREATMENT  OF  EPILEPTICS. 

Soon  after  the  opening  of  the  colony  it  was  found  that 
some  restless  patients  from  the  poorhouses  and  almshouses, 
among  whom  were  those  most  needing  colony  treatment, 
would  leave  without  permission,  and  that  the  Superintend- 
ent could  not  legally  restrain  them  from  doing  so.  These 
patients  would  sometimes  return  to  the  colony  in  a  pitiable 
condition,  bereft  of  the  advantages  of  their  previous  treat- 
ment. Under  these  conditions  the  management  found  that 
the  real  aims  of  the  colony  were  in  a  measure  defeated,  and 
the  attention  of  the  Legislature  was  directed  to  the  subject. 
This  embarrassment  was  overcome  by  Chapter  359,  Laws  of 
1898,  which  provides  that  the  Superintendent,  subject  to  the 
supervision  and  control  of  the  Board  of  Managers,  shall 
have  the  custody  of  patients  admitted  to  the  colony  and 
enforce  such  discipline  as  he  may  deem  to  be  for  the  inter- 
ests of  the  patients  and  of  the  colony. 

CRAIG    COLONY. 

The  Genesee  Valley,  the  garden  of  the  State,  in  which  is 
situated  the  Craig  Colony,  was  designated  by  the  proud 
Iroquois  the  Beautiful  Valley.  With  its  temperate  climate, 
its  streams  of  pure  water,  and  its  immense  forest  trees  and 
other  luxuriant  growths  produced  by  the  richness  of  the 
soil,  it  was  regarded  by  the  pioneer  immigrants  as  the  land 
of  promise.  The  term  Sonyea,  the  name  of  the  old  Indian 
village  on  the  site  of  which  the  colony  is  founded,  signifies 
in  the  Indian  language  a  "  warm  or  sunny  place."  This  fair 
domain  for  the  helpless,  homeless  beings  to  whom  the  State 
has  extended  a  gentle,  ministering  hand  lies  on  the  west 
side  of  the  valley,  the  surface  in  the  southern  portion  rolling 
gently  to  the  east,  and  in  the  northern  part  extending  into  al- 
luvial bottom-lands.    The  situation  seems  admirably  adapted 


CRAIG   COLONY  IOI 

by  nature  for  the  humane  purpose  to  which  it  is  devoted 
through  the  wise  benevolence  of  a  great  commonwealth. 

Through  the  centre  of  the  tract,  dividing  it  into  two 
about  equal  portions, flows  the  Cashaqua '  Creek — a  stream  of 
sufficient  volume  to  create  a  good  water-power,  with  a  fall  of 
about  105  feet  within  the  boundaries  of  the  colony.  It  de- 
scends from  the  hills  through  a  rocky  and  picturesque  gorge. 
Another  small  stream  fed  by  springs  flows  through  the  prop- 
erty on  the  west  side  of  the  creek. 

The  sides  of  the  valley  rise  gradually  on  either  side,  and 
in  the  distance  hills  are  seen  which  are  often  white  with 
snow  in  the  spring  and  fall  when  the  fields  and  meadows 
of  Sonyea  are  fresh  and  green.  The  landscape  is  exceed- 
ingly attractive,  and  the  eye  is  charmed  as  one  surveys 
from  an  elevated  position  the  large  orchards  comprising 
every  variety  of  fruit  grown  in  this  climate,  the  extensive 
and  highly  productive  gardens,  the  herds  of  cattle,  the 
sheep  grazing  in  the  pastures,  the  cultivated  fields,  broad 
meadows,  groups  of  patriarchal  trees,  and  Arcadian  vistas 
stretching  on  and  on  beyond  the  boundary  of  the  colony  to 
the  dim  line  of  the  horizon.  About  six  hundred  acres  of  the 
estate  are  still  covered  with  original  forest,  which  is  looked 
to  as  a  source  of  supply  in  the  development  of  future  indus- 
tries. The  colony  is  further  favored  in  the  variety  of  its 
soil — about  one  quarter  being  a  rich  alluvial  deposit,  about 
three  eighths  having  an  admixture  of  clay,  and  the  re- 
mainder being  of  a  quality  well  adapted  to  market-garden- 
ing purposes,  and  to  the  cultivation  of  peaches,  pears, 
cherries,  apricots,  apples,  etc. 

The  colony  is  situated  about  three  miles  from  Mount 
Morris,  a  pleasant  village  containing  about  two  thousand 

1  This  word  is  spelled  by  different  authorities  Cashaqua,  Kashaqua,  and 
Kishaqua.     Its  Indian  signification  is  "loving  stream." 


102  CARE  AND    TREATMENT  OF  EPILEPTICS. 

five  hundred  inhabitants — far  enough  from  its  temptations 
and  activities  to  afford  the  needed  seclusion  and  quiet  es- 
sential to  such  a  colony,  and  at  the  same  time  near  enough 
to  be  in  touch  with  its  markets,  business  interests,  and 
social  life.  The  colony  is  about  sixty-eight  miles  from  Buf- 
falo and  thirty-nine  from  Rochester,  and  may  be  reached 
by  the  Erie  Railway  and  by  the  Western  New  York  and 
Pennsylvania  Railway,  which  runs  in  a  general  direction 
north  and  south  and  has  connections  with  the  trunk  lines 
running  east  and  west  through  the  State.  The  latter  road 
has  recently  erected  an  attractive  station  on  the  creek  and 
near  the  centre  of  the  tract,  and  a  station  in  rustic  style  has 
recently  been  built  by  the  Erie  Railway  Company  within 
the  boundaries  of  the  colony  estate. 

At  the  time  the  State  was  so  fortunate  as  to  come  into 
possession  of  this  valuable  property  there  were  thirty  build- 
ings of  various  kinds  upon  it.  These  were  mostly  in  two 
groups,  called  by  the  Shakers  East  House  and  West  House. 
There  were  some  shops  and  a  large  saw-,  planing-,  and  grist- 
mill on  the  creek,  some  large  barns  here  and  there,  and 
a  few  remote  and  scattered  residences  for  hired  farm 
workmen  and  their  families.  In  an  examination  made  of 
the  buildings  by  the  writer  with  a  competent  architect  be- 
fore the  acquisition  of  the  property,  their  value  was  esti- 
mated in  round  figures  at  $75,000. 

In  the  East  group,  now  occupied  by  women,  is  a  massive 
building  called  the  Letchworth  House.  It  is  strongly  con- 
structed of  excellent  brick  made  on  the  place.  To  this  has 
been  added  a  broad  veranda,  which  has  pleasant  outlooks 
upon  the  park  in  front  of  it.  This  substantial  structure  is 
now  used  principally  for  dormitory  purposes,  the  rooms 
averaging  about  six  beds  each.  Its  capacity  is  for  130 
female  patients.     On  the  first  floor  is  a  large  and  pleasant 


FARMSTEAD 

1 

Cow  Barn. 

2 

Hen  House. 

3 

Root  Cellar. 

4 

Stable. 

5 

Farmer's  House. 

6 

Granary. 

7 

Wagon  Shed. 

8,  9 

Patients'  Houses 

1  Letchworth  House. 

2  Hospital. 

3  Administration  Building. 

4  Patients'  Dormitory. 

5  Dining  Hall. 

6  Steward  s  House. 

7  Laundry. 

8  Store  House. 

9  Ice  House. 

10  Laboratory. 

1 1  School  House. 

12  Superintendent  s  House 


WEST  GROUP. 

1  Patients'  Building 

2  Kitchen. 

3  Heating  Plant. 

4  Industries. 

5  Cow  Barn. 


Olmsted  Brothers,  Landscape  Architects 
Brookline,  Mass., Nov.  16 


CRAIG    COLONY, 


CRAIG   COLONY.  103 

room,  with  a  spacious  open  fireplace,  used  as  a  sitting-room, 
a  library,  and  a  reading-room.  In  this  building  are  shower- 
baths,  and  on  each  floor  are  bath-tubs,  closets,  and  lavato- 
ries. In  the  basement  is  located  the  hot-water  heating 
apparatus  that  serves  to  heat  most  of  the  buildings  of  the 
East  group. 

At  the  rear  of  the  Letchworth  House  is  a  one-story  brick 
structure,  which  contains  a  dining-room  for  patients,  a 
dining-room  adjoining  for  nurses,  a  kitchen  supplied  with 
all  modern  appliances,  and  a  bakery,  cold-storage  rooms, 
etc.     This  building  is  now  called  The  Inn. 

A  few  rods  to  the  right  of  the  first-named  building  is  a 
large  two-story  wooden  structure  called  The  House  of  the 
Elders,  having  retained  the  name  given  it  by  the  Shakers, 
by  whom  it  was  used  for  their  peculiar  worship.  The  upper 
floor  is  now  devoted  to  dormitory  purposes  and  the  lower 
floor  is  used  as  an  assembly-room,  which  is  available  for  re- 
ligious services,  lectures,  and  entertainments.  It  seats  about 
260  persons.  Religious  services  are  held  here  every  Sunday, 
and  are  conducted  by  Presbyterian,  Methodist,  Baptist, 
and  Episcopal  clergymen,  and  a  Roman  Catholic  priest,  in 
rotation.  A  large  glazed  solarium  extending  along  one 
side  of  the  building  has  been  added  by  the  managers. 

A  little  farther  on  in  the  same  direction  stands  a  recently 
erected  two-story  brick  building  accommodating  twenty 
boys.  In  consideration  of  the  long  association  of  Dr. 
Charles  S.  Hoyt  with  the  State  Board  of  Charities  and  his 
faithful  public  service,  this  building  has  been  named  by  the 
managers  Hoyt  Cottage. 

A  little  rearward  of  the  House  of  the  Elders  is  a  plain 
two-story  cottage,  to  which  a  veranda  has  been  added.  It  is 
occupied  by  fifteen  female  patients,  and  is  called  Tall 
Chief  Cottage,  after  an  Indian  chief  whose  name  is  histori- 


104  CARE  AND    TREATMENT  OF  EPILEPTICS. 

cally  associated  with  this  locality.  But  a  few  rods  from 
Tall  Chief  Cottage  is  The  Elms,  a  two-story  building  tem- 
porarily used  for  a  laundry,  an  ironing-room,  and  a  sewing- 
room.  It  has  all  the  modern  appliances  for  laundering,  and, 
with  its  busy  and  apparently  cheerful  workers,  makes  a 
pleasant  impression  upon  the  visitor.  Near  at  hand  is  the 
little  Shaker  schoolhouse,  with  the  same  quaint  desks  that 
were  used  by  this  sedate  and  circumspect  people. 

In  this  group  is  also  the  orderly  storehouse  of  the  colony. 
Here  a  ledger  account  is  kept  of  all  kinds  of  supplies,  show- 
ing the  amount  received  and  the  amount  given  out  on  requi- 
sition. The  account  is  written  up  so  as  to  show  at  any  time 
the  quantity  of  each  article  on  hand.  A  short  distance 
from  this  is  the  icehouse,  with  a  capacity  for  311  tons.  It 
is  supplied  with  ice  from  the  small  lake,  fed  by  springs, 
which  is  close  by  this  group.  Within  the  icehouse  is  a 
cold-storage  chamber  for  meats,  with  a  capacity  for  14,000 
pounds,  and  a  second  one  for  butter  and  other  perishable 
articles.  Belonging  to  this  group  is  also  a  cottage  which 
has  been  converted  into  a  pleasant  temporary  residence  for 
the  Superintendent.  All  the  buildings  stand  on  a  rising 
piece  of  ground  but  a  few  minutes'  walk  from  the  railway 
stations. 

There  has  been  added  to  this  group  the  administration 
building  of  the  colony,  a  large  and  imposing  brick  structure. 
On  the  first  floor  of  this  building  are  the  Board  room,  li- 
brary, Superintendent's  office,  and  departments  for  the  stew- 
ard, bookkeeper,  and  stenographer.  A  dining-room,  with  a 
kitchen  adjoining,  is  provided  for  the  use  of  the  officers.  The 
spacious  reception-hall  is  lighted  by  skylights.  All  the  med- 
ical records  are  kept  in  a  fire-proof  vault  in  this  building. 
The  physicians  meet  at  a  certain  hour  each  day  to  write  up 
the  records  and  give  such  information  as  may  be  required 


CRAIG   COLONY.  105 

concerning  the  patients.  On  the  second  floor  are  eleven  bed- 
rooms averaging  sixteen  feet  square  for  the  use  of  officers 
and  employees.  These  include  assistant  physicians,  the 
bookkeeper,  storekeeper,  stenographer,  typewriters,  and 
ushers.  The  capacious  attic  is  given  up  to  storerooms  and 
accommodations  for  the  night-nurses  and  night-watchman. 

Within  a  stone's  throw  westerly  is  the  Peterson  Hospital 
for  the  treatment  of  acute  medical  and  surgical  cases.  It 
was  opened  in  January,  1898,  and  occupies  a  commanding 
site.  It  is  a  two-story  brick  building  with  bluestone  trim- 
mings, and  is  built  so  as  to  secure  plenty  of  light  and  sun- 
shine. It  cost  $25,000,  and  accommodates  twenty-six 
patients.  The  per  capita  expense  for  the  resident  inmates 
was  a  little  less  than  $1000.  To  the  right  of  the  entrance 
is  a  spacious  office  for  the  use  of  the  assistant  medical  staff, 
in  the  rear  of  which,  with  an  intervening  corridor,  are  the 
living-apartments  of  the  resident  medical  officer.  On  the 
left  are  the  physical-examination  room,  a  dark  room  for 
photographic  purposes,  toilet-room,  etc.  Communicating 
with  a  lateral  corridor  from  the  main  hall  are  the  dispensary 
and  drugroom,  patients'  waiting-room,  and  druggist's  bed- 
room. The  kitchen  is  situated  at  the  extremity  of  the  main 
hall.  On  the  second  floor,  at  the  right,  are  two  rooms  for 
cases  requiring  isolation,  a  ward  for  five  or  six  female  pa- 
tients, a  pleasant  convalescents'  room,  bathroom,  closets, 
lavatory,  and  wardrobe.  The  floor  space  at  the  left,  which 
is  occupied  by  men,  is  a  counterpart  of  that  at  the  right. 
Over  the  main  hall  is  the  operating-room.  A  dining-hall 
for  patients  and  attendants  occupies  the  space  above  the 
kitchen. 

This  building  will  always  be  more  than  a  simple  hospital. 
It  has  provision  on  the  first  floor  for  an  outdoor  depart- 
ment similar  to  that  found  in  the  general  hospitals  in  the 


106  CARE   AND    TREATMENT  OF  EPILEPTICS. 

great  cities.  Embracing,  as  the  colony  does,  a  large  num- 
ber of  separate  households,  the  dispensing  of  medicine  is 
more  difficult  than  it  would  be  in  a  congregate  institu- 
tion. Medicines  are  given  out  to  supervisors  upon  the 
recorded  prescriptions  of  a  medical  officer  at  a  certain  hour 
each  day,  and  are  taken  by  the  supervisors  to  their  several 
departments,  where  they  are  kept  in  a  locked  cabinet  acces- 
sible only  to  the  visiting  physician,  the  supervisor,  and  the 
head  nurse.  Under  no  circumstances  are  patients  allowed 
to  keep  drugs,  stimulants,  or  a  remedy  of  any  kind  in 
their  possession  except  by  express  permission  of  the  phy- 
sician in  charge ;  nor  is  any  new  line  of  treatment  or  experi- 
ment permitted  except  with  the  knowledge  of  the  medical 
superintendent  of  the  colony. 

In  the  waiting-room  of  the  hospital  patients  congre- 
gate for  examination  by  the  physicians,  and  for  advice. 
Female  patients  are  given  two  hours  each  morning  and 
male  patients  two  hours  in  the  afternoon.  From  the  wait- 
ing-room they  go  into  the  physical-examination  and  con- 
sulting room.  Here  minor  wounds  are  dressed,  and  injuries 
caused  by  accidents  receive  careful  attention.  These  rooms 
are  always  in  charge  of  a  trained  nurse  during  the  hours 
they  are  in  use. 

It  is  eminently  fitting  that  this  building,  devoted  to  hos- 
pital purposes,  should  have  been  named  after  one  who, 
through  years  of  persistent  effort  and  large  personal  sacri- 
fice, did  so  much  towards  establishing  the  first  real  agricul- 
tural colony  for  epileptics  in  America. 

From  plans  prepared  by  the  architect,  working  in  con- 
junction with  the  President  and  the  Superintendent  of  the 
colony,  a  laboratory  with  mortuary  has  been  built  of  stone 
and  brick,  near  the  hospital,  at  a  cost  of  $3000  for  the  struc- 
ture and  $1500  for  apparatus  and  furnishing.     The  building 


CRAIG   COLONY.  107 

embraces  a  well-lighted  basement  for  holding  autopsies,  and 
a  room  for  the  temporary  preservation  of  bodies.  The 
laboratory  proper  is  on  the  floor  above,  in  two  large  separate 
rooms  completely  furnished  and  equipped  with  all  modern 
scientific  instruments  for  the  prosecution  of  laboratory  work. 
From  a  scientific  point  of  view,  this  department  will  be  of 
great  value  in  the  study  of  epilepsy.  It  is  hoped  that  by 
this  means  much  may  be  learned  concerning  the  causes  of 
epilepsy  as  well  as  the  results  of  the  disease.  It  will  be  a 
physiological  and  chemical  laboratory  as  well  as  a  pathologi- 
cal one.  Dr.  Ira  Van  Gieson,  of  New  York,  has  been  ap- 
pointed consulting  pathologist,  and  Dr.  C.  A.  Herter,  of 
New  York,  consulting  pathological  chemist. 

The  West  group  is  situated  about  half  a  mile  wester- 
ly from  the  East  group,  and  consists  of  one  capacious 
wooden  structure,  four  smaller  buildings,  and  a  large  heavy- 
timbered  barn  standing  a  little  apart.  The  first-named 
building  has  been  fitted  up  with  sitting-rooms,  dormitories, 
lavatories,  and  bathrooms  to  accommodate  about  sev- 
enty-five patients.  There  are  nine  single  rooms  for  private 
patients.  The  dormitories  are  comfortably  furnished. 
The  bedsteads  have  woven-wire  springs,  and  are  supplied 
with  mattresses  made  at  the  colony.  There  are  rugs  on 
the  floors  and  pictures  on  the  walls.  One  of  the  buildings 
is  used  for  a  dining-hall,  with  kitchen  adjoining  and  officers' 
rooms  above.  The  interior  finish  is  of  Georgia  pine.  The 
table  furniture  is  tasteful,  and  the  chairs  are  rendered  noise- 
less by  covering  the  feet  with  rubber.  Nine  sit  at  each  table. 
The  large  kitchen  is  a  model  of  neatness  and  convenience. 
Another  of  the  buildings  has  an  assembly-room  on  the  lower 
floor  and  rooms  above  fitted  up  for  patients;  another,  the 
smallest,  is  for  the  accommodation  of  officers ;  and  the  other 
is  used  at  present  for  printing,  shoemaking,  mattress-work, 


108  CARE  AND    TREATMENT  OF  EPILEPTICS. 

harness-making,  and  other  trades.  Aside  from  the  work- 
shop, the  cost  of  converting  these  buildings  into  their 
present  uses  and  furnishing  them  was  effected  at  a  per 
capita  outlay  of  $150.  They  are  heated  by  hot  water  and 
lighted  by  electricity.  Cement  walks  are  laid  between  the 
different  buildings  in  this  group  as  well  as  between  those  of 
the  East  group.  Slate  roofs  have  been  laid  on  most  of  the 
old  buildings  of  the  colony. 

About  a  quarter  of  a  mile  from  the  West  group  the  man- 
agers have  built  two  cottages  for  employees  who  have 
families. 

One  of  the  two  immense  barns  of  the  Shakers,  removed 
to  a  more  convenient  and  central  situation  near  the  creek, 
is  the  most  prominent  object  in  the  farmstead  group.  The 
barn  has  been  remodelled,  and  a  basement  added,  which 
provides  for  stalling  116  head  of  cattle.  New  buildings 
have  been  erected,  including  a  granary,  root-cellar,  hennery, 
slaughter-house,  piggery,  and  a  modern  stable  with  a  range 
of  sheds  attached.  The  stable  accommodates  twenty-six 
horses.  There  are  also  three  new  cottage  residences  in  this 
group,  one  of  which  is  occupied  by  the  head  farmer. 

There  has  been  erected,  near  the  station,  a  two-story 
brick  building  for  industrial  purposes.  A  corridor  25  x  25 
feet  connects  two  wings  each  25  x  75  feet.  The  build- 
ing includes  a  general  repair  shop,  carpenter's  shop,  black- 
smith's shop,  upholstering-rooms,  printing-office,  and  a 
sloyd  room.  It  has  accommodations  for  forty  workmen. 
It  is  supplied  with  electrical  power  from  the  power-house. 
The  latter  has  a  steam-engine  of  80-horse  power  and  a 
dynamo  capacity  for  supplying  1040  electric  lights.  Bitu- 
minous coal  is  used  in  generating  steam.  The  location  of 
the  power-house  is  central  and  supplies  the  needs  of  the 
whole  colony. 


ADMINISTRATION    BUILDING   (Craig  Colony). 


PETERSON    HOSPITAL    'Craig  Colony!. 


CRAIG   COLONY.  IO9 

Convenient  to  the  industrial  building  a  couple  of  two- 
story  brick  structures  have  been  erected,  each  accom- 
modating thirty-two  patients.  Downstairs  are  the  main 
sitting-  and  dining-rooms;  upstairs,  dormitories  and  smaller 
sitting-rooms.  Suitable  rooms  are  provided  for  nurses,  and 
each  building  is  complete  in  itself  with  the  exception  of 
facilities  for  laundering  and  bread-making. 

The  colony  is  supplied  with  water  from  two  sources, — 
one  being  Cashaqua  Creek,  and  the  other  hillside  springs,  the 
water  from  which  is  conducted  into  a  small  reservoir  near 
them.  A  steel  tower  75  feet  high  and  15  feet  in  diameter 
is  erected  on  the  highest  ground  of  the  colony.  It  contains 
an  upright  cylinder  yj  feet  high  and  4  feet  in  diameter, 
holding  7000  gallons.  The  outer  space  holds  90,000  gallons. 
The  inner  cylinder  is  supplied  with  spring  water,  which  is 
used  for  domestic  and  culinary  purposes.  By  means  of  a 
small  steam  force-pump  at  the  reservoir,  water  is  forced  into 
the  inner  cylinder  of  the  tower,  from  which  it  flows  in 
small  pipes  to  the  different  buildings  of  the  colony.  In  all 
the  departments  using  spring  water  the  pipes  have  faucets 
which  permit  the  water  to  flow  only  under  hand  pressure. 
The  outer  cylinder  is  for  creek  water.  At  the  power- 
house on  Cashaqua  Creek  large  pumps  force  the  water 
through  capacious  pipes  from  the  creek  to  the  tower, 
whence  it  is  distributed  for  fire-protection,  toilet,  laundry, 
and  sewerage  purposes.  The  capacity  of  the  pump  is 
1,440,000  gallons  daily.  The  gravity  pressure  is  sixty 
pounds  to  the  square  inch,  enabling  a  stream  of  water  to  be 
thrown  over  the  highest  building.  By  direct  action  of  the 
pump  the  water  can  be  forced  to  an  elevation  of  120  feet. 
The  distribution  of  hydrants  is  such  as  to  afford  protection 
to  every  building,  and  a  well-equipped  fire  department  is 
trained  to  bring  them  into  use  in  case  of  necessity.     By 


IIO  CARE  AND    TREATMENT  OF  EPILEPTICS. 

means  of  this  dual  system,  an  abundance  of  both  pure 
spring  water  and  creek  water  is  supplied  to  every  house  in 
the  colony.  The  consumption  of  the  latter  is  seventy 
gallons  a  day  per  capita.  Since  the  opening  of  the  colony 
there  has  been  no  case  of  illness  of  any  kind  that  could  be 
traced  to  impure  drinking-water. 

The  system  of  disposing  of  the  sewage  of  the  colony 
includes  a  trunk  line  from  the  West  group  to  the  East  group 
and  thence  to  filter-beds  by  the  creek.  The  filter-bed  at 
present  in  use  covers  one  acre.  It  is  intended  to  build 
along  the  line  of  the  sewer  between  the  East  and  West 
groups  moderate-sized  cottages  on  both  sides  of  a  village 
green  or  street. 

Having  gone  over  the  work  of  the  managers  in  renovating 
the  old  buildings  of  the  colony,  making  them  comfortable 
and  healthful  places  of  living,  and  shown  what  structures 
have  been  added  since  the  property  was  purchased  by  the 
State,  we  may  now  look  in  the  direction  in  which  future 
developments  are  contemplated.  The  present  water-supply 
system  and  electric  plant  are  sufficient  for  the  accommoda- 
tion of  one  thousand  patients;  the  sewerage  system  pro- 
vides for  only  five  hundred  patients. 

The  pressure  for  admission  when  the  colony  was  first 
opened  and  when  it  could  receive  but  very  few  patients  was 
unfavorable  to  the  carrying  out  of  principles  which  it  was  in- 
tended should  govern  it.  Proper  classification  could  not  be 
observed;  there  was  too  much  of  institutional  crowding; 
the  households  were  too  few, — all  tending  to  a  generally 
disturbed  condition.  Perhaps  most  regrettable  of  all  were 
the  commingling  of  children  and  adults  and  incomplete  sepa- 
ration of  the  sexes.  These  conditions  have  been  overcome 
as  far  as  legislative  appropriations  would  admit,  but  much 
remains  to  be  done  to  perfect  the  system  contemplated. 


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LETCHWORTH    HOUSE    (Craig  Colony  >. 


HOYT    COTTAGE    '  Craig  Colony  >. 


CRAIG   COLONY.  Ill 

To  meet  the  earnest  desire  of  the  managers  to  remove  all 
the  women  and  children  to  the  east  side  of  Cashaqua  Creek, 
an  appropriation  of  $100,000  was  made  by  the  Legislature 
of  1898  for  a  group  of  eleven  buildings,  which  are  about 
completed.  They  are  planned  to  accommodate  258  patients 
and  are  estimated  to  cost,  including  plumbing,  and  heating 
and  lighting  facilities,  ready  for  furniture,  $387  per  capita. 
The  group  as  planned,  for  convenience  in  describing,  may 
be  subdivided  into  three  groups. 

Group  I.  contains  the  centre,  or  main,  structure,  numbered 
1,  on  either  side  of  which  are  buildings,  numbered  2  and  3, 
each  for  forty  children  and  their  teachers  and  nurses.  The 
outside  dimensions  of  the  main  building  are  48  x  120  feet. 
On  the  first  floor  is  a  large  vestibule  opening  into  a  general 
hallway,  from  which  extends  to  the  right  and  the  left  a  cen- 
tral corridor.  To  the  left  of  the  entrance  are  the  general 
office,  reception-room  for  patients'  friends,  drugroom  for 
medical  supplies,  etc.  There  are  also  four  rooms  for  teachers 
and  assistant  physicians,  including  a  woman  physician  for 
this  group.  At  the  right  of  the  hallway  on  entering  are  the 
matron's  office  and  private  room.  Opening  from  the  right 
corridor  are  the  dining-room  for  officers,  kitchen,  and  two 
living-rooms  for  domestics.  On  this  floor  are  the  necessary 
bath-  and  toilet-rooms,  linen-closets,  and  pantries.  On  the 
second  floor  are  rooms  for  ten  of  the  better  class  of  adult 
patients,  also  a  large  sitting-room,  sewing-room,  dining- 
room,  bathroom,  and  closets  of  different  kinds  for  the  use 
of  the  patients. 

It  is  thought  that  about  twenty  per  cent,  of  all  the  pa- 
tients in  the  colony  will  be  under  sixteen  years  of  age,  and 
that  such  patients  should  be  specially  provided  for.  In  ad- 
dition to  a  sitting-room,  dining-room,  kitchen,  and  associate 
dormitory,  the  two  structures  in  this  group  for  children  have 


112  CARE  AND    TREATMENT  OF  EPILEPTICS. 

on  the  first  floor  of  each  a  large  schoolroom,  kindergarten- 
room, and  workroom,  which  are  thought  to  be  necessary  either 
in  buildings  in  which  children  live,  or  in  such  close  prox- 
imity to  them  that  they  may  be  used  in  all  kinds  of  weather 
and  by  the  most  frail  and  delicate  children.1  On  the  sec- 
ond floor  there  are  two  rooms  for  teachers,  a  sewing-room, 
two  lavatories,  six  bedrooms,  four  associate  dormitories  for 
six  beds  each,  besides  linen-  and  other  closets.  Each  of  the 
buildings  is  provided  with  a  shower-bath,  also  a  winter  play- 
or  sitting-room  12  x  44  feet.  The  latter  is  on  the  first  floor 
and  enclosed  with  glazed  sash.  The  communication  be- 
tween these  buildings  and  the  central  structure  is  by  means 
of  a  cement  walk,  over  which  is  a  wooden  trellis  supported 
by  columns  of  classic  design.  The  intention  is  to  cover  this 
with  vines. 

Group  II.  comprises  four  buildings  of  uniform  design, 
numbered  4,  5,  10,  and  II,  two  of  which  lie  to  the  east  and 
two  to  the  west  and  a  little  in  the  rear  of  Group  I.  The 
capacity  of  each  of  the  four  cottages  is  for  thirty  adult 
patients,  or  one  hundred  and  twenty  in  all.  Each  building 
has  two  separate  entrances,  two  separate  sitting-rooms,  and, 
on  the  second  floor,  separate  bedrooms  and  small  dormi- 
tories, for  the  purpose  of  extending  classification.  The 
kitchen  and  dining-room  are  in  common,  with  a  view  to 
greater  economy. 

Group  III.  comprises  four  cottages,  numbered  6,  7,  8, 
and  9,  still  farther  in  the  rear  of  Group  I.  and  parallel  with 
it.  These  are  lined  from  east  to  west,  and  arranged  in 
pairs.  The  buildings  of  each  pair  are  fifty  feet  apart,  and 
the  space  between  the  pairs  is  one  hundred  feet.  The  cot- 
tages in  both  pairs  are  connected  by  covered  ways.  The 
capacity  of  each  cottage  is  for  twelve  patients.  It  is  the 
1  At  present  children  are  not  received  younger  than  seven  years  of  age. 


TEMPORARY    RESIDENCE    OF    SUPERINTENDENT    (Craig  Colony 


INDUSTRIAL    BUILDING    '.Craig  Colony 


TALL    CHIEF   COTTAGE    (Craig  Colony). 


CRAIG   COLONY.  II3 

intention  to  put  in  these  houses  patients  who  can  do  most 
of  the  household  work, — make  their  own  beds,  clean  their 
own  rooms,  set  the  tables,  wash  dishes,  and  do  the  lighter 
laundry  work, — everything,  in  fact,  except  working  over  the 
range  in  the  kitchen.  There  will  be  one  hired  person  in 
each  household. 

The  cottages  in  this  group  have  each  a  veranda  twelve 
feet  wide  extending  along  the  front  of  the  house.  At  the 
entrance  there  is  a  vestibule  opening  into  a  broad  hallway. 
On  the  first  floor  of  these  buildings  are  a  dining-room  and 
a  sitting-room  on  opposite  sides  of  the  hall.  Each  of  these 
rooms  is  provided  with  an  open  fireplace.  Besides  the 
kitchen  and  the  pantry,  there  is  also  a  room  on  this  floor 
for  two  employees.  On  the  second  floor  is  a  large,  well- 
lighted  hall.  Opening  from  this  hall  are  three  large  bed- 
rooms for  two  beds  each.  There  are  also  six  single  rooms 
for  patients,  besides  closets,  a  bathroom,  etc. 

The  stairways  in  all  the  buildings  are  broken  by  two  or 
three  broad  landings.  The  corners  of  newel-posts,  door- 
casings,  mouldings,  and  baseboards — in  fact,  all  the  corners 
of  woodwork — are  rounded  in  such  a  manner  as  to  permit 
the  least  possible  injury  to  patients  should  they  happen  to 
fall  against  them.  The  sleeping-apartments  are  so  planned 
that  no  bed  need  be  placed  before  a  window  or  near  a  heater. 
The  buildings  are  lighted  by  electricity  generated  at  the 
power-house,  and  heated  by  steam  generated  in  a  fire-proof 
room  in  the  basement  of  the  main  building.  Steam-pipes 
are  carried  from  the  main  building  through  sewer-pipe  to 
steam  radiators  in  the  various  apartments.  The  radiators 
are  fastened  securely  to  the  wall  and  are  protected  by  a 
light  screen. 

The  buildings  have  stone  foundations  to  the  water-table, 
thence  upward  to  the  eaves  they  are  constructed  of  brick. 

8 


114  CARE  AND    TREATMENT  OF  EPILEPTICS. 

The  roofs  of  the  buildings  are  covered  with  tin  painted  the 
color  of  red  tile. 

It  is  the  intention,  as  means  are  appropriated,  to  add 
other  cottages  to  this  group,  making  enough  to  provide 
ultimately  for  a  female  population  of  from  eight  hundred  to 
one  thousand.  Besides  the  cottages  for  patients  to  live  in, 
there  will  be  an  assembly-hall  constructed  on  the  east  side 
of  the  creek,  also  a  separate  hospital  building.  The  en- 
tire group  of  buildings  on  this  side  of  the  creek  will  be 
supervised  by  an  assistant  physician,  under  whom  there  will 
be  in  turn  a  corps  of  medical  and  other  officers.  Ultimately 
the  whole  colony  will  be  in  divisions,  each  division  consist- 
ing of  numerous  separate  households,  with  an  assistant 
physician  in  charge  of  a  given  division. 

The  principle  governing  the  development  of  the  colony  is 
that  of  perfecting  an  aggregation  of  small  houses  or  a  village 
of  houses  in  which  each  house  has  its  distinct  kitchen  serv- 
ice. In  this  way  food  may  be  served  as  in  a  private  family 
and  individual  requirements  more  nearly  met.  There  are 
now  forty-one  houses  upon  the  colony  estate. 

An  appropriation  of  $7500  was  made  by  the  Legislature 
of  1898  to  build  a  superintendent's  residence  on  the  west 
side.  The  site  selected  for  it  is  on  an  elevation  above 
Cashaqua  Creek,  about  three  minutes'  walk  from  the  admin- 
istration building,  and  is  commanding  and  picturesque.  An 
appropriation  of  $8000  was  made  at  the  same  time  for  a 
laundry  department  on  the  east  side.  Both  of  these  build- 
ings are  now  completed. 

The  pressure  for  admission  to  the  colony  increases  rather 
than  diminishes.  More  than  seven  hundred  applications 
are  now  on  file.  Many  of  the  appeals  for  admission  are 
extremely  pitiful.  Superintendent  Spratling  says:  "Could 
I  command  the  language  of  a  thousand  tongues,  I  could 


CRAIG  COLONY.  115 

not  express  the  earnest  hopes,  the  anxious  inquiries,  the 
pathetic  appeals  that  daily  reach  the  colony  pleading  relief 
for  some  afflicted  father,  mother,  or  child."  From  Super- 
intendents of  the  Poor  there  is  a  strong  demand  for  admis- 
sion to  the  colony  of  a  class  of  aged,  infirm,  and  demented 
epileptics  who  are  in  the  poorhouses  and  almshouses,  and 
of  whom  little  can  be  expected  in  the  way  of  improvement. 
They  are  a  source  of  great  care  and  embarrassment  in  county 
houses,  where  there  is  very  indifferent  provision  for  them. 
Yielding  to  this  pressure,  the  managers  of  the  colony  asked 
of  the  Legislature  an  appropriation  for  two  infirmary  build- 
ings,— one  for  forty-four  women  on  the  east  side  and  one 
for  an  equal  number  of  men  on  the  west  side. 

It  was  also  found  necessary  to  ask  for  means  to  provide 
separately  for  temporarily  disturbed  cases  who  require  iso- 
lation for  periods  lasting  from  twenty-four  hours  to  a  week 
or  possibly  longer.  During  last  year  there  were  twenty 
that  required  isolation  for  an  aggregate  period  of  276  days. 

In  occasional  visits  to  the  colony  interviews  were  had 
with  its  principal  officers,  for  the  purpose  of  more  thor- 
oughly understanding  the  Craig  Colony  system.  The  notes 
made  on  these  occasions,  with  statements  of  the  officers,  are 
now  used. 

Dr.  Wm.  P.  Spratling,  Superintendent,  before  coming  to 
the  colony  was  for  five  years  first  assistant  physician  at  the 
State  Hospital  for  the  Insane,  Morristown,  New  Jersey. 
Having  a  preference  for  his  present  special  work,  he  al- 
lowed his  name  to  be  placed  on  the  civil-service  list  of  com- 
petitors for  Superintendent  of  Craig  Colony.  Receiving  the 
highest  mark  of  merit,  he  resigned  his  position  at  Morris- 
town  and  accepted  his  present  office.  Before  entering  upon 
its  duties  he  made  a  trip  to  Bielefeld  and  entered  the  Bethel 
Colony,  living  among  its  patients  and  studying  the  colony 


Il6  CARE  AND    TREATMENT  OF  EPILEPTICS. 

methods  for  several  weeks.  His  previous  experience  and 
his  study  of  the  Bielefeld  system  are  of  great  advantage  in 
his  present  labors.  He  holds  to  the  maxim,  Mens  sana 
in  corpore  sano  and  has  strong  faith  in  the  potency  of  pure 
air,  exercise,  and  proper  diet.  Dr.  Spratling  is  in  the  prime 
of  life,  a  man  of  large-hearted  sympathies,  and  full  of  en- 
thusiasm in  his  work.  Mrs.  Spratling,  an  amiable  and 
accomplished  woman,  although  spending  most  of  her  time 
with  household  duties  devolving  upon  the  wife  and  mother, 
in  sustaining  her  husband  is  no  inconsiderable  factor  in  the 
colony  life.  Upon  her  devolves  the  duties  of  social  hospi- 
tality to  the  many  visitors  who  go  almost  daily  to  the 
colony  to  study  its  methods, — a  task  she  is  eminently  fitted 
for  and  which  she  always  delightfully  performs. 

"  Our  first  endeavor,"  said  Dr.  Spratling,  "  is  to  get  the 
patient  in  good  bodily  health.  We  examine  his  teeth,  to 
see  that  he  has  the  means  of  mastication.  It  avails  little 
to  give  a  patient  food  unless  he  can  properly  masticate  and 
digest  it.  We  endeavor  to  remove  causes  of  indigestion  and 
weakness,  which  increase  the  frequency  of  attacks.  The 
dietetic  treatment  we  consider  as  important  as  the  medicinal. 
That  is  why  we  lay  so  much  stress  on  the  condition  of  the 
mouth." 

The  patients  on  admission  are  subjected  to  a  thorough 
and  critical  medical  examination.  It  may  be  extended  for 
several  days,  in  the  effort  to  obtain  satisfactory  evidence  of 
the  nature  of  the  case  and  the  cause  of  the  malady.  Blanks 
are  sent  to  relatives,  friends,  or  physicians — to  any  one 
who  knows  most  about  the  patient — to  be  filled  out  and 
returned.  From  this  and  other  sources  all  obtainable 
data  are  gleaned  and  recorded  after  the  case  has  been 
diagnosed. 

At  the  outset  a  patient  is  permitted  to  go  about  and  make 


CRAIG   COLONY.  1 1 7 

the  acquaintance  of  other  patients  and  of  the  nurses.  He 
is  afterwards  employed  as  seems  most  consistent  with  his 
welfare. 

The  hours  for  meals  in  summer  are  6  A.M.,  12  M.,  and  6 
P.M.  The  bulk  of  the  food  consists  of  cereals,  fruit,  milk, 
butter,  eggs,  and  vegetables,  which  are  produced  on  the 
farm.  Puddings,  pies,  pastry,  and  sweetmeats  are  avoided. 
The  food  is  carefully  prepared  by  cooks  who  are  required  to 
pass  a  civil-service  examination  in  practical  cookery.  The 
same  care  is  exercised  in  providing  a  meal  as  in  compound- 
ing a  prescription.  The  matron  supervises  closely  the  prep- 
aration of  the  food.     She  says : 

"  From  the  vegetable  dietary  cabbages  and  cucumbers 
are  excluded  and  the  supply  of  potatoes  is  limited.  Soup 
is  permitted  every  day,  because  it  is  nutritious,  and,  at 
the  same  time,  serves  to  dull  the  usually  keen  appetite 
of  the  epileptic ;  but  great  pains  is  taken  that  it  does  not 
contain  greasy  or  other  indigestible  substances.  Tea,  which 
is  a  favorite  beverage  with  epileptics,  is  very  carefully  pre- 
pared. Freshly  boiled  water  is  poured  over  the  leaves  and 
allowed  to  stand  from  three  to  five  minutes.  The  liquid  is 
then  poured  from  the  leaves  and  kept  hot  until  ready  for 
use.  Coffee,  made  from  freshly  ground  berries,  is  mixed 
with  beaten  eggs  and  cold  water  and  placed  where  it  can 
come  slowly  to  the  boiling-point.  It  is  kept  just  below  that 
point  for  twenty  minutes,  then  the  necessary  quantity  of 
boiling  water  is  added,  and  it  is  ready  to  serve.  Beef,  mut- 
ton, chicken,  or  fish  is  allowed  but  once  a  day.  Of  these, 
beef  is  most  frequently  served.  To  roast  the  beef  it  is  put 
into  a  very  hot  oven,  in  order  that  the  surface  may  be  seared 
before  the  juices  escape.  After  a  crust  is  formed  the  oven 
is  cooled  somewhat  and  the  meat  frequently  basted  to  pre- 
vent its  drying  and  to  distribute  the  heat  evenly  over  the 


118  CARE  AND    TREATMENT  OF  EPILEPTICS. 

surface.     The  bread  is  baked  in  a  brick  oven  of  the  latest 
and  most  approved  kind." 

The  patients  are  weighed  on  admission  and  every  month 
thereafter.  Two  hundred  patients  weighed  prior  to  one 
of  my  visits  showed  an  aggregate  gain  of  five  hundred 
pounds.  No  patient  had  lost  in  weight.  Strict  attention 
to  diet,  with  cleanliness  and  regular  habits,  reduces  the 
number  of  seizures. 

No  two  patients  are  amenable  to  precisely  the  same  kind 
of  medical  treatment ;  but  in  all  cases  the  aim  is  to  build  up 
the  physical  system  by  means  of  proper  food,  outdoor  exer- 
cise, and  regular  habits.  Some  improve  without  any  other 
remedy.  Others  may  be  suffering  from  disordered  stom- 
achs, chronic  diarrhoea,  or  intestinal  trouble,  to  whom  it  is 
necessary  to  administer  drugs. 

On  being  asked  about  the  use  of  bromide  of  potassium, 
Dr.  Spratling  replied:  "  It  is  very  much  used,  to  the  injury 
of  the  epileptic.  I  am  convinced  that  it  does  a  great  deal 
of  harm.  Many  come  here  in  a  condition  of  what  we  call 
bromism.  They  are  stupid,  dull,  and  seem  bordering  on 
dementia.  They  have  no  energy  for  work,  and  are  per- 
fectly listless.  They  are  suffering  in  many  ways  from  the 
effects  of  liberal  doses  of  bromide,  and  the  skin  is  highly  in- 
flamed. Foul  spots  are  discovered  all  over  their  bodies. 
Among  the  first  things  we  do  with  them  is  to  wean  them 
from  the  use  of  bromide.  We  put  them  under  another 
course  of  treatment  and  try  to  build  them  up.  The  extent 
to  which  bromide  is  administered  by  some  poorhouse-keep- 
ers  is  alarming.  Where  we  give  it  once  in  three  or  four 
weeks  they  administer  it  daily.  We  had  a  man  here  who 
took  forty-five  grains  every  night  for  five  years.  The  news- 
papers are  filled  with  '  fit  cures,'  which  are  mostly  made  up 
of  bromide  of  potassium  in  powerful  solution.     It  palliates, 


. — 


k.   £-1 


o 

c 
o 

!    a 


It     l_ 


fCil 


■  c    Ufa!'- 


CRAIG  COLONY  II9 

but  does  not  cure.     It  checks  and  weakens  the  attacks,  but 
does  not  prevent  their  recurrence." 

A  remarkable  case  may  be  cited  in  this  connection.  It  is 
that  of  a  man  who,  at  the  age  of  twenty-eight,  was  admitted 
to  the  colony.  He  had  a  sunstroke  when  only  eight  years 
old,  and  ever  since  had  been  subject  to  frequent  epileptic 
seizures.  He  was  discharged  from  two  of  the  State  hos- 
pitals for  the  insane  as  being  incurable  and  likely  soon  to 
die.  Eminent  experts  of  Philadelphia  and  of  New  York 
thought  his  case  hopeless.  It  was  written  up  in  the  case 
records  as  "  perfectly  demented."  He  was  taken  home  by 
a  sorrowing  mother,  as  she  thought,  to  die.  It  was  at  this 
time  that  Commissioner  Foster,  of  the  New  York  State 
Board  of  Charities,  interested  himself  in  the  case,  and  had 
the  young  man  sent  to  Craig  Colony  in  February,  1896. 
The  first  month  he  had  180  seizures;  the  second,  113;  the 
third,  3 ;  the  fourth,  1.  After  that,  down  to  the  time  of  his 
discharge,  he  did  not  have  a  seizure.  What  is  no  less  re- 
markable for  a  man  who  had  been  considered  by  physicians 
as  demented,  he  learned  a  trade.  When  admitted,  he  was 
described  as  a  locksmith,  but  he  did  not  appear  to  know  a 
lock  from  a  stone.  He  was  regarded,  therefore,  as  having  no 
calling.  Under  intelligent  supervision,  however,  he  took 
gradually  to  the  printer's  art,  and  finally  had  full  charge  of 
the  printing-office.  This  man  had  been  receiving,  previous 
to  his  admission  to  the  colony,  as  high  as  140  grains  of 
bromide  a  day.  His  allowance  was  reduced  to  fifteen 
grains  night  and  morning  as  soon  as  he  reached  Sonyea. 
This  after  a  time  was  still  further  reduced  to  fifteen  grains 
at  night  without  any  in  the  morning.  His  physical  condi- 
tion was  so  low  that  he  could  not  walk  without  support. 
Pure  air,  sunshine,  proper  diet,  medical  supervision,  and 
regular  habits  wrought  in  him  what  seems  like  a  miracle. 


120  CARE  AND  TREATMENT  OF  EPILEPTICS. 

This  man  weighed  when  admitted  120  pounds.  At  the  end 
of  a  year  his  weight  was  136  pounds.  He  was  discharged 
from  the  colony  April  27,  1898.  It  is  reported  that  he  has 
had  no  fits  since,  and  that  he  is  now  earning  a  living  for 
himself  and  his  mother. 

The  following  is  a  somewhat  remarkable  record  respect- 
ing the  first  fifty  patients  admitted  and  their  condition  at 
the  end  of  five  months  of  colony  life : 

FIRST  MONTH.         FIFTH  MONTH. 

Total  number  of  seizures 708  315 

Average  individual  seizures....     14  6 

After  the  patients  have  resided  a  few  months  at  the  col- 
ony the  changed  expression  of  their  countenances  is  very 
marked.  The  dull,  apathetic  look,  acquired  perhaps  through 
years  of  indolence  and  neglect,  disappears.  The  effects  of 
occupation,  education,  and  intelligent  treatment  upon  the 
general  physical  and  mental  development  become  clearly 
apparent.  No  patient  is  discharged  as  recovered  until  two 
years  have  elapsed  from  the  time  of  his  last  seizure.  A 
correspondence  is  maintained  with  every  patient  for  two 
years  after  his  discharge. 

Dr.  Spratling  is  ably  assisted  in  the  medical  work  by  Dr. 
L.  Pierce  Clark,  Assistant  Physician,  Dr.  Marie  Louise 
Benoit,  Medical  Interne,  and  Dr.  E.  A.  Sharp,  Medical 
Interne. 

Before  entering  the  service  of  the  colony,  Dr.  Clark  had 
a  year's  experience  in  the  New  York  City  Hospital,  and 
served  a  similar  length  of  time  in  the  New  York  City 
Asylum,  after  which  he  had  an  experience  of  eighteen 
months  in  the  Connecticut  State  Hospital  for  the  Insane 
at  Middletown. 

Dr.  Benoit  is  a  graduate  of  the  U-niversity  of  Buffalo. 


COTTAGES    FOR    WORKING    PATIENTS    'Craig  Colony) 


STEWARD'S    RESIDENCE    <Craig  Colony). 


RAILWAY   STATION.     MEN'S    INDUSTRIAL    BUILDING      (Craig  Colony". 


CRAIG   COLONY  121 

Prior  to  coming  to  the  colony  she  was  in  active  practice  for 
a  year  and  studied  about  the  same  length  of  time  abroad. 
Her  knowledge  of  foreign  languages  makes  her  services  of 
additional  value  to  the  colony. 

The  medical  records  of  the  colony  are  very  complete  and 
present  an  interesting  study.  Each  case  is  duly  recorded 
in  the  admission  book,  where  the  social  status  of  the  patient 
is  noted,  together  with  his  or  her  status  as  an  epileptic.  The 
admission  paper  is  copied  into  the  case  record  book,  and 
this  entry  is  supplemented  from  time  to  time  with  notes 
regarding  the  progress  of  the  disease  and  the  condition  of 
the  patient.  The  history  of  the  patient  prior  to  admission 
is  copied  into  the  special  record  book.  Here  also  are  re- 
corded such  cases  as  are  deemed  of  exceptional  scientific 
interest.  In  the  monthly  record  of  seizures  each  case  has  a 
folio  by  itself.  Yet  another  book  contains  a  record  of  stig- 
mata of  degeneration  together  with  hereditary  ailments. 
Separate  records  set  forth  the  daily  medical  treatment  of 
each  case  for  epilepsy,  also  the  treatment  of  diseases  or  ail- 
ments other  than  epileptic. 

Dr.  Clark  finds  that  the  seizures  are  less  frequent  in 
summer  than  in  winter,  a  fact  which  may  be  accounted  for 
by  the  increased  opportunities  for  outdoor  employment  in 
the  summer  months.  On  one  of  my  visits  there  were  fifty- 
six  seizures  in  the  space  of  twenty-four  hours.  At  other 
times  the  number  would  be  as  low  as  fifteen  a  day. 

The  night-nurse  attached  to  each  household  makes  a 
careful  note  of  each  attack.  Every  attack  occurring  by 
night  or  by  day  is  duly  observed  and  reported.  Every 
patient  on  parole,  visiting  friends,  is  carefully  instructed  as 
to  diet,  exercise,  and  the  use  of  medicine,  a  supply  of  which 
is  allowed  to  each,  so  that  the  medical  treatment  may  be 
continuous.     For  the  use  of  patients  who  go  away  from  the 


122  CARE  AND    TREATMENT  OF  EPILEPTICS. 

colony  for  a  few  days  there  is  given  what  is  called  a  "  rec- 
ord card, ' '  the  purpose  of  which  is :  first,  to  preserve  a  record 
of  all  seizures  and  their  kind,  whether  by  night  or  day, 
mild  or  severe,  and  whether  attended  with  dizzy  spells, — all 
of  which  conditions  are  indicated  by  characters;  second, 
to  serve  as  a  guide  as  to  what  to  eat  and  what  not  to 
eat ;  third,  as  a  means  of  identification  if  the  patient  has  a 
seizure  in  a  strange  place.  Included  in  the  list  of  foods  not 
to  eat  are  pastry  and  cake  of  all  kinds,  rich  puddings,  pork, 
veal,  ham,  or  anything  fried  in  grease,  or  any  food  highly 
seasoned.  The  use  of  alcoholic  beverages  of  all  kinds  is 
forbidden.  Coffee  may  be  drunk  for  breakfast,  but  not  for 
supper  if  it  causes  wakefulness.  Weak  tea  may  be  used 
sparingly.  Patients  are  enjoined  to  eat  slowly  and  masti- 
cate thoroughly. 

The  supervision  of  the  matron  of  the  colony,  Miss  Eliza- 
beth D.  Holt,  not  only  includes  the  duties  usually  belong- 
ing to  that  office,  but  extends,  through  her  philanthropic 
spirit,  to  the  mental,  moral,  and  physical  development  of 
the  women  and  children  patients.  The  true  devotional 
spirit  which  has  worked  such  wonders  at  Bielefeld,  and 
without  which  it  is  to  be  feared  only  a  modicum  of  success 
is  likely  to  attend  these  humanitarian  undertakings,  is  every- 
where apparent  in  the  supervision  of  the  domestic  affairs  of 
Craig  Colony.  Rare  gifts  of  nature,  supplemented  by  a 
two  years'  course  in  the  New  York  City  Hospital  and  a 
special  course  in  domestic  science  in  the  New  York  Teach- 
ers College,  have  peculiarly  fitted  Miss  Holt  for  her  difficult 
and  patience-trying  duties.  When  we  called  at  her  office, 
she  was  found  seated  in  front  of  a  small  table  surrounded 
by  ten  girls  whose  ages  ranged  from  twelve  to  fifteen  years. 
They  were  clean,  quiet,  well-behaved,  neatly  clad  children. 
Their  faces  wore  a  cheerful  look.     Their  hair  was  neatly 


<    I 

tr     < 


CRAIG  COLONY  123 

combed  and  tied  with  different-colored  ribbons.  It  was 
evident  the  matron  and  her  pupils  were  on  familiar  terms, 
but  not  too  familiar  to  interfere  with  discipline.  The 
teacher's  love  seemed  to  be  reciprocated.  What  a  contrast 
with  the  old  poorhouse  life ! 

"  This  is  not  school,"  Miss  Holt  hastened  to  say  upon 
our  unexpected  entrance,  "  but  merely  a  little  gathering  of 
the  children  here  in  my  office.  This  afternoon  they  have 
been  cutting  out  pictures  and  learning  how  to  paste  them 
neatly  into  a  scrap-book.  They  learn  in  this  way  the  use 
of  a  pair  of  scissors  and  are  at  the  same  time  trained  to 
observe  carefully,  so  as  not  to  spoil  the  pictures.  The  eye 
and  hand  are  trained  simultaneously.  At  other  times  they 
learn  to  set  the  table  by  means  of  toy  dishes ;  also  how  to 
wait  on  the  table.  We  have  a  sort  of  kitchen-garden,  includ- 
ing lessons  in  sweeping  and  bed-making.  The  children  also 
learn  how  to  braid  hair,  using  threads  of  worsted  for  this 
purpose.  Lessons  on  deportment  are  also  included.  Classes 
are  formed  in  sewing,  mending,  darning,  and  rug-making, 
in  gymnastics,  marching,  and  walking,  together  with  weav- 
ing and  basket-making.  There  are  object-lessons  for  the 
feeble-minded.  They  are  taught  to  observe  and  handle  the 
most  common,  every-day  objects,  as  many  of  the  children 
are  ignorant  of  the  names  and  uses  of  such  articles.  It  is 
just  such  practical,  simple  things  that  I  try  to  teach."  It 
was  a  very  pretty  picture.  The  quiet  maintained  was 
particularly  noticeable.  Not  a  sound  of  discord.  All 
seemed  intent  on  simple  tasks,  so  skilfully  directed  as  to 
be  made  deeply  interesting  as  well  as  instructive. 

In  reply  to  a  question  about  the  nurses,  Dr.  Spratling 
said: 

We  take  people  of  middle  age,  who  are  strong  physi- 
cally and  sound  mentally.     Sometimes  it  requires  a  good 


124  CARE  AND    TREATMENT  OF  EPILEPTICS. 

deal  of  strength  on  the  part  of  both  male  and  female  nurses 
to  care  for  the  patients  during  violent  seizures,  when  they 
are  likely  to  injure  themselves.  In  the  second  place,  we 
try  to  get  persons  who  are  kind,  able  to  exercise  a  good  deal 
of  patience  and  forbearance,  and,  above  all  things,  to  con- 
trol their  own  tempers.  The  reason  for  this  is  that  epilep- 
tics, as  a  rule,  are  so  irritable  and  so  trying  to  the  patience 
of  others  that  it  requires  a  saintly  disposition  to  bear  with 
them.  Having  selected  promising  candidates,  we  have  a 
civil-service  examination  in  rudimentary  branches,  so  as  to 
test  their  ability  to  keep  the  records.  Our  local  board  of 
civil-service  examiners  consists  of  the  first  and  second  assist- 
ant physicians  and  the  matron.  The  doctors  examine  them 
with  a  view  to  the  proper  care  of  epileptics,  and  the  matron 
questions  them  upon  methods  and  details  of  housekeeping. 
After  they  pass  the  examination  they  are  appointed  for  a 
probationary  period  of  three  months,  and  if  they  are  inca- 
pable of  meeting  our  requirements,  we  can  dismiss  them  at 
any  time.  The  compensation  ranges  from  $16  to  $26  a 
month  for  women,  and  $18  to  $28  a  month  for  men." 

There  are  three  kinds  of  nurses,  namely,  trained,  house, 
and  labor  nurses.  The  first  are  engaged  principally  in  the 
hospital  caring  for  acute  medical  and  surgical  cases.  As  in 
the  United  States  Army  hospitals,  female  nurses  are  pre- 
ferred who  are  willing  to  assume  the  care  of  male  patients. 
House  nurses  are  occupied  in  the  care  and  supervision  of 
households  made  up  of  from  twelve  to  thirty  patients.  It 
is  their  duty  to  see  that  cleanliness  and  order  are  observed 
in  all  matters  of  housekeeping,  and  that  patients  who  are 
obliged  to  remain  indoors  are  properly  cared  for.  It  is  the 
duty  of  the  labor  nurses  to  accompany  the  patients  when 
they  are  required  to  go  to  the  fields,  gardens,  or  shops,  and 
work  with  them  while  instructing  them.     This  is  the  method 


COTTAGES    FOR    OFFICERS.      WATER-TOWER    (Craig  Colony). 


«i^"v  -7  ■;''"-     A^j/i   y       y\*"*»X'         as  ?*--  ..  "   »  »-'  ••» 


PATIENTS    HOEING    CORN    (  Craig  Colony'. 


GARDEN    AND    LAKE    ICraig  Colony  ». 


CRAIG   COLONY  1 25 

pursued  at  the  Bethel  Colony,  where  the  nurses  not 
only  work  with  their  charges,  but  eat  at  the  same  tables 
and  sleep  in  the  same  dormitories  with  them ;  truly  a  high 
degree  of  self-sacrifice,  and  devotion  to  humanitarian  work. 

The  general  ratio  is  one  nurse  to  ten  patients.  There  is 
one  night-nurse  in  charge  of  a  building  or  small  group  of 
patients,  with  one  patient  who  acts  as  assistant  night-nurse. 

The  training  of  nurses  to  care  for  epileptics  differs  little 
from  that  of  other  hospital  nurses.  They  are  taught  the 
principles  of  first  aid  to  the  injured,  so  as  to  be  able  to 
act  promptly  and  intelligently  in  case  of  accident.  They 
must  be  able  to  treat  minor  injuries  by  applying  a  bandage 
or  stanching  a  wound.  They  must  know  all  that  the  trained 
hospital  nurse  is  required  to  know  about  bedside  work,  tak- 
ing temperatures,  noting  the  respiration,  pulse,  etc.  The 
women  nurses  must  in  addition  be  able  to  cook  for  their 
charges.  They  must  know  how  in  case  of  sickness  to  make 
toast,  beef-tea,  and  other  delicacies.  Cookery  is  an  import- 
ant branch  of  the  Training  School  for  Nurses,  which  the 
women  are  required  to  attend  three  hours  every  week. 

In  selecting  the  men,"  said  Dr.  Spratling,  "  we  prefer 
farmers'  sons  of  twenty-four  or  twenty-five  years,  whose 
characters  are  pretty  well  formed  and  who  have  received  a 
good  industrial  education.  We  prefer  young  men  who  know 
but  little  of  city  life,  and  who  have  not  acquired  habits  of 
dissipation." 

By  the  advice  and  authority  of  the  Attorney-General,  a 
uniformed  officer,  empowered  to  make  arrests,  is  on  duty 
during  the  day,  for  the  better  preservation  of  discipline  and 
order.     There  are  also  night-patrols. 

How  to  occupy  the  mind  and  at  the  same  time  provide 
suitable  exercise  for  the  body  is  one  of  the  most  interesting 
problems  now  being  solved  at  Craig  Colony.     Superintend- 


126  CARE  AND    TREATMENT  OF  EPILEPTICS. 

ent  Spratling  believes  in  alternating  the  physical  and  mental 
exercises.  "  Otherwise,"  he  says,  "  there  would  be  a  tend- 
ency to  atrophy  of  mind  or  body,  whichever  happened  to  be 
neglected."  A  co-equal  development  of  both  is  what  is 
aimed  at.  With  this  object  in  view  the  day's  routine  is 
agreeably  diversified,  physical  labor  for  not  too  long  a 
period  being  followed  by  mental  training  and  amusement. 

The  industrial  principles  of  the  colony  are  emphasized  as 
of  great  importance,  while  the  evils  of  "  all  work  and  no 
play  "  are  carefully  avoided.  "  We  have  demonstrated  con- 
clusively the  great  value  of  work  in  the  treatment  of  epi- 
lepsy," said  Dr.  Spratling.  "  The  connection  between 
frequency  of  seizures  and  no  work  has  been  so  clearly  shown 
that  we  insist  on  every  patient  doing  something.  On  rainy 
days  or  in  extremely  cold  weather,  when  patients  are  in- 
doors and  idle,  the  attacks  are  doubled  in  frequency.  They 
become  cross  and  irritable.  At  such  times  they  are  more 
liable  to  fits,  and  every  seizure  tends  to  retard  their  chances 
of  cure.  Outdoor  employment  is  important  above  every- 
thing else.  After  a  man  has  exercised  out-of-doors  he 
comes  in  with  a  healthy  appetite  for  his  food,  and  is  able  to 
digest  what  he  eats.  When  he  retires  with  his  system 
charged  with  ozone  and  rests  comfortably,  nature,  instead 
of  drugs,  acts  the  part  of  a  restorer.  We  favor  almost  any- 
thing that  will  induce  the  patients  to  sleep  well." 

Most  of  the  men  work  six  hours  a  day  on  the  farm,  in  the 
garden,  or  taking  care  of  stock.  The  women,  too,  go  out  in 
groups  to  work  in  the  garden  in  summer,  always  in  charge 
of  "nurses. 

Aside  from  the  occupations  connected  with  farming  the 
men  are  engaged  in  printing,  shoemaking,  tailoring,  black- 
smithing,  harness-making,  and  other  industries.  The  en- 
gineer and  the  fireman  at  the  power-house  have  each  two 


PATIENTS    DIGGING    POTATOES   'Craig  Colony). 


PATIENTS   CLEARING    LAND    '  Craig  Colony). 


EIGHT    EPILEPTIC    CARPENTERS    BUILDING    A    HOUSE   (CRAI3  Colony'. 

ALL    GRADUATES   OF    THE    C.    C.    SLOYO    SCHOOL. 


CRAIG   COLONY  12J 

patients  assisting  them.  Two  patients,  who  are  blacksmiths 
and  skilled  workers  in  iron,  do  all  the  horseshoeing  for  the 
colony,  besides  repairing  wagons,  etc.  All  the  job  printing 
of  the  colony  is  done  by  the  patients.  During  winter  some 
of  the  men  are  employed  clearing  land  and  cutting  brush- 
wood, with  a  view  to  beautifying  the  grounds  and  preparing 
wood  for  kindling.  In  the  not  distant  future  it  is  anticipated 
that  the  shoeshop  will  furnish  all  the  shoes  required  for  the 
colony,  and  that  patients  will  be  able,  under  proper  super- 
vision, not  only  to  erect  the  kind  of  structures  most  desira- 
ble for  the  colony  life,  but  also  to  manufacture  all  the 
necessary  interior  furniture.  Nature  has  furnished  on  the 
grounds  an  abundance  of  material  for  brick  and  for  timber. 
Many  of  the  women  are  employed  in  sewing,  crocheting, 
and  embroidering.  Once  a  year  an  exhibition  of  their 
needlework  is  given  in  their  assembly-room.  This  serves 
to  stimulate  them  to  take  pride  in  their  work.  Dr.  Spratling 
says :  "  Many  epileptics  are  peculiarly  inconstant.  By  vir- 
tue of  the  disorganizing  and  disintegrating  powers  of  their 
disease,  it  is  extremely  difficult  for  them  to  acquire  any 
useful  habit.  They  like  to  change  from  one  thing  to  an- 
other. Much  coaching  and  constant  supervision  are  neces- 
sary. The  patient  who  has  led  an  almshouse  life  knows  at 
least  something  of  what  discipline  means, — knows  he  can  go 
so  far  and  no  farther.  Boys  and  girls  who  have  led  a  spoiled 
life  at  home  are  less  amenable  to  colony  discipline;  on  the 
other  hand,  they  have  more  commendable  pride  and  more 
self-respect  than  those  who  have  become  institutionized. 
The  spiritless  condition  of  those  who  have  resided  a  long 
time  in  the  great  city  almshouses  of  New  York  and  Brook- 
lyn is  pitiable  to  behold.  They  seem  to  be  mere  human 
machines.  Speak  to  them,  and  they  respond  with  hanging 
heads  and  stupid  stare.     They  look  as  if  all  spirit  had  been 


128  CARE  AND    TREATMENT  OF  EPILEPTICS. 

crushed  out  of  them.  It  is  difficult  to  induce  patients  who 
have  acquired  the  almshouse  antipathy  to  work  to  take 
kindly  to  any  form  of  employment ;  but  during  twelve  months 
this  aversion  is  gradually  dissipated.  Men  and  women  who 
formerly  shirked  work  now  take  cheerfully  and  naturally 
to  six  or  seven  hours  a  day.  The  example  of  the  nurses 
working  with  the  patients  and  performing  an  equal  amount 
of  labor  seems  to  have  a  healthy  moral  influence  in  bringing 
about  this  result." 

On  the  occasion  of  a  visit  made  to  the  colony  July  20, 
1898,  the  patients  were  employed  as  follows: 

Of  the  men,  20  were  employed  on  the  farm,  8  on  the 
lawn,  23  in  the  garden,  16  at  housework,  2  at  painting,  2  in 
the  power-house,  2  were  assisting  the  fireman,  2  were  em- 
ployed at  carpentry,  2  as  messengers,  2  in  the  storeroom,  2 
at  surveying,  1  at  tailoring,  2  in  the  blacksmith's  shop,  2  in 
the  laundry,  2  in  the  horse-barn,  2  in  the  cow-barn,  1  in  the 
bakery,  5  in  the  kitchens,  3  in  the  scullery,  4  in  the  dining- 
room,  1  as  assistant  night-nurse,  1  in  the  clothes-room,  1  in 
the  printing-office,  1  in  the  hennery,  1  at  the  filter-bed,  and 
I  as  porter.  Seventeen  men  were  working  in  the  brickyard, 
producing,  under  the  supervision  of  experienced  workmen, 
12,000  brick  a  day.  Seventy-six  per  cent,  of  the  male 
patients  were  engaged  in  useful  labor,  to  which  seven  or 
eight  hours  of  the  day  were  devoted.  The  market  value  of 
their  labor  was  about  $30  a  day. 

Of  the  women,  9  were  employed  in  the  laundry,  18  in  the 
sewing-room,  11  in  the  dining-room,  11  in  the  kitchen,  14 
in  the  scullery,  35  at  housework,  1  in  the  storeroom,  1  in 
the  clothes-room,  2  as  messengers,  2  on  the  lawn,  and  25  in 
the  garden.  Eighty  per  cent,  of  the  women  were  usefully 
employed. 

Twelve  boys  from  ten  to  fifteen  years  of  age  were  in 


PATIENTS    GATHERING    APPLES   'Craig  Colony). 


PATIENTS    MAKING    BRICK    'Craig  Colony 


SLOYD    SCHOOL    FOR    BOYS    (Craig  Colony 


CRAIG   COLONY  1 29 

charge  of  an  attendant,  who,  under  the  direction  of  a  pro- 
fessional gardener,  instructed  them  in  gardening  during  the 
forenoon.     In  the  afternoon  the  boys  attend  school. 

Much  pains  is  taken  to  prevent  the  possibility  of  accidents 
to  patients  in  their  varied  occupations,  and  a  watchful 
supervision  is  exercised  over  them  by  night  and  by  day. 
A  portable  mattress  with  a  pillow  attached  is  taken  to  the 
field  by  laborers,  to  be  used  in  case  of  seizures,  and  stretch- 
ers are  always  at  hand  to  carry  the  helpless  in  a  decent  and 
orderly  manner. 

Under  the  supervision  of  Farmer  Kingston,  who  was  man- 
ager for  the  Shaker  community,  the  farm  yielded  in  1897 
about  three  thousand  bushels  of  wheat,  averaging  from 
twenty-eight  to  thirty-eight  bushels  to  the  acre,  and  several 
thousand  bushels  of  potatoes,  at  the  rate  of  from  one  hun- 
dred and  fifty  to  three  hundred  bushels  to  the  acre.  Corn 
yielded  at  the  rate  of  one  hundred  bushels  in  the  ear  to  the 
acre.  There  was  an  enormous  yield  of  sugar-beets,  and  as 
several  hundred  acres  are  specially  adapted  to  their  growth, 
the  sugar-beet  industry  is  looked  to  as  a  possible  source  of 
revenue.  The  yield  of  fruit  from  forty  acres  of  orchard  was 
also  large.  The  Superintendent  reports  that  the  total  value 
of  the  farm  and  garden  products  of  the  colony  for  the  first 
year  of  its  operations  was  $14,230.20,  and  for  the  second 
year  $25,810.08.  During  the  year  ending  September  30, 
1898,  the  products  of  the  farm  and  the  various  departments 
of  the  colony  amounted  to  $36,889.03.  There  is  slaughtered 
at  the  colony  all  the  beef  that  is  used,  and  all  the  mutton 
consumed  is  produced  upon  the  colony  farm. 

In  the  last  two  years  the  farm  has  been  greatly  developed. 
The  flock  of  sheep  has  grown  from  eighty  to  three  hun- 
dred, besides  those  that  have  been  used  as  food  for  the 
colony.     It  is  hoped  in  time  to  perfect  the  industrial  depart- 


130  CARE  AND    TREATMENT  OF  EPILEPTICS. 

ment  so  as  to  manufacture  cloth  from  wool  grown  on  the 
place.  In  utilizing  the  extensive  range  of  pasture  young 
cattle  are  purchased,  and  the  increase  in  value  from  their 
growth  becomes  a  source  of  revenue  to  the  colony. 

The  programme  of  amusements  is  as  diverse  as  that  of 
labor.  The  women  while  away  a  pleasant  hour  at  innocent 
games,  and  entertainments  which  please  the  patients  and 
arouse  the  mental  faculties  are  frequently  provided.  There 
is  dancing  in  the  assembly-room  once  a  week.  Stereopti- 
con  lectures  in  winter  have  proved  very  interesting. 

To  no  one  department  is  more  attention  given  than  that 
of  providing  amusements  which  call  into  play  bodily  exer- 
cise and  muscular  activity,  but  the  system  of  recreation  is 
not  yet  perfected  on  account  of  the  newness  of  the  colony 
and  a  lack  of  means  to  carry  out  the  plan  in  view.  The 
theory  that  the  stronger  you  make  a  man's  muscles  the 
stronger  you  make  his  brain  was  put  in  practice  by  the 
Superintendent,  and  the  result  has  not  been  disappointing. 
A  field  containing  about  five  acres  of  ground  is  devoted  to 
athletic  sports,  military  drill,  and  games  requiring  agility 
and  expertness.  Within  the  outer  limits  of  the  grounds  is 
a  half-mile  bicycle  and  foot-race  track.  The  interior  green- 
sward space  is  used  for  baseball,  lawn-tennis,  and  croquet 
grounds.  Dressing-  and  toilet-rooms  and  accommodation 
for  seating  spectators  are  here  provided. 

The  entire  system  of  recreation  and  amusements  is  under 
the  direction  of  a  physician,  and  his  instructions  are  given 
to  a  supervisor,  who  is  always  on  the  ground  when  the 
patients  are  exercising  to  see  that  the  physician's  directions 
are  carried  out.  A  feeble  patient,  especially  one  with  weak 
heart  and  lungs,  is  not  allowed  to  go  through  violent  exer- 
cise. Only  those  patients  whose  muscles  have  been  gradu- 
ally developed  by  physical  training  are  permitted  to  indulge 


CRAIG   COLONY  131 

in  extraordinary  feats.  Those  boys  who  have  made  a  record 
in  vaulting  have  been  gradually  trained  to  their  present 
degree  of  proficiency.  It  is  said  that  it  is  an  extremely 
rare  occurrence  for  a  patient  to  have  a  seizure  on  the  athletic 
grounds,  and  in  no  instance  have  the  exercises  proved 
detrimental. 

The  managers  desire  to  secure  a  legislative  appropriation 
for  a  gymnasium,  a  bowling-alley,  and  a  billiard-room,  which 
are  especially  needed  during  the  winter  months.  The 
legal  holidays  are  observed  by  appropriate  exercises  and 
entertainments.  The  Fourth  of  July  is  made  an  occasion 
of  especial  interest.  Music,  parades,  athletic  sports,  and 
evening  illuminations  are  included  in  the  programme.  The 
patients  enjoy  a  half-holiday  Wednesdays  and  Saturdays 
during  July  and  August.  Sunday  is  of  course  always  a  day 
of  rest.  The  assembly-hall  is  used  for  religious  services 
Sunday  and  for  lectures  and  entertainments  during  the  week. 
The  circulating  library,  which  includes  the  best  magazine 
literature  of  the  day,  is  a  popular  feature  of  the  colony. 

A  love  of  flowers  and  the  cultivation  of  them  are  encour- 
aged among  the  patients.  A  floral  reception  given  by  Mrs. 
Spratling  soon  after  the  colony  opened  resulted  in  dona- 
tions of  some  two  hundred  potted  plants,  which  were  cared 
for  by  the  patients. 

One  of  the  principal  objects  of  the  colony  is  to  provide 
schools  for  children  who,  by  the  nature  of  their  disease, 
are,  like  their  elders,  debarred  from  association  with  their 
more  fortunate  fellow-mortals.  "  The  greatest  work  this 
colony  will  ever  do,"  said  Superintendent  Spratling,  "  will 
be  with  the  young  epileptic," 

The  school  for  women  and  children  is  in  charge  of  Miss 
E.  Luella  Coffin,  who  has  had  previous  experience  in  the 
instruction  of  defective  children,  and  is  well  qualified  for  her 


I32  CARE  AND    TREATMENT  OF  EPILEPTICS. 

responsible  position.  The  education  of  these  unfortunate 
persons  appeals  so  forcibly  to  the  feminine  nature  that 
many  regard  it  as  peculiarly  woman's  work.  Certain  it  is 
that  women  are  naturally  quicker  than  men  to  discern  that 
wisdom  in  simplicity  which  never  fails  to  captivate  the  child 
heart,  and  which  is  best  calculated  to  set  in  motion  the 
child  mind.  It  must  be  remembered,  too,  that  many  adult 
epileptics  are  mentally  children,  and  that  their  lessons  are 
necessarily  simple  and  practical.  The  same  lessons,  there- 
fore, that  are  taught  the  boy  and  girl  of  ten  are  taught  many 
of  the  adult  patients.  To  be  able  to  write  a  letter  or  ad- 
dress an  envelope  is  a  common  ambition.  The  younger 
pupils  seem  to  enjoy  the  drawing  lessons.  The  school 
opens  at  9  A.M.  for  the  girls,  and  remains  in  session  until 
11.30.     There  is  an  afternoon  session  for  the  boys. 

In  addition  to  the  day-school,  a  night-school  has  been 
organized  for  adults.  Lectures  given  from  time  to  time 
by  the  teachers  are  very  helpful.  Calisthenics  and  military 
drill  are  also  features  of  the  colony  life.  The  summer  walks 
in  the  garden  and  through  the  fields  are  made  a  means  of 
instruction  as  well  as  pleasure,  the  teachers  upon  these  oc- 
casions striving  to  instil  into  the  minds  of  the  patients  a 
knowledge  of  the  plant  and  animal  life  by  which  they  are 
surrounded,  thus  leading  them  to  see 

"  Tongues  in  trees,  books  in  the  running  brooks, 
Sermons  in  stones,  and  good  in  everything." 

The  school  records  show  what  progress  has  been  made 
from  month  to  month  by  individual  pupils  in  school  exer- 
cises. Dr.  Clark  is  firmly  convinced  that  the  education  of 
the  epileptic  child  should  proceed  on  very  different  lines 
from  the  education  of  the  feeble-minded.  He  finds  frequent 
epileptic  seizures  and  attendant  mental  weakness  accom- 


SENECA  INDIAN    GIRL   ^PATIENT'  IN   COSTUME   FOR    EVENING   ENTERTAINMENT 
<  Craig  Colony). 


PATIENTS    DANCING    AT    ENTERTAINMENT    (Craig  Colony 


CRAIG   COLONY.  1 33 

panied  by  impairment  of  memory.  When  the  seizures 
become  less  frequent  the  power  of  memory  returns  suffi- 
ciently to  enable  the  patient  to  derive  more  or  less  bene- 
fit from  educational  training.  At  other  times  the  patient 
lacks  all  power  of  concentration  and  has  little  or  no 
capacity  for  receiving  the  ideas  sought  to  be  conveyed. 
The  aim  of  the  teacher  is  to  catch  the  pupil  when  his  or 
her  mind  is  in  a  condition  to  assimilate  the  knowledge 
sought  to  be  imparted.  The  bright  pupils  are  selected  for 
special  attention. 

A  sloyd  school  constitutes  one  of  the  departments  of  the 
industrial  building.  It  is  under  the  direction  of  Augustus 
T.  Hatch,  a  graduate  of  Bowdoin  College  and  of  the  Sloyd 
Training  School  of  Boston.  The  present  class  consists  of 
twenty  boys.  About  half  of  them  will  soon  graduate, 
when  they  will  be  engaged  in  carpentering,  cabinet-work, 
and  in  making  repairs  about  the  institution.  The  aim  is  to 
teach  them  a  trade  and  develop  them  intellectually.  It  is 
intended  in  time  to  teach  other  trades,  including  black- 
smithing  and  masonry. 

A  class  of  sixteen  girls  also  receives  instruction  in  manual 
training.  Their  work,  including  whittling,  is  much  lighter 
than  that  done  by  the  boys.  There  are  also  classes  in 
basket-weaving,  sewing,  etc. 

The  heating,  lighting,  and  sewerage  systems  of  the  colony 
have  proved  satisfactory.  The  general  healthfulness  of  the 
place  corroborates  the  affidavit  of  Deacon  Work,  one  of 
the  Shaker  community,  made  previous  to  the  purchase  of 
the  site.  Deacon  Work  declared  that  during  the  twenty- 
five  years  the  property  had  been  occupied  by  the  Shakers, 
with  an  average  population  of  one  hundred  persons, 
there  had  been  no  case  of  malaria,  typhoid  or  other  fever, 
and    but    one    case    of    pulmonary    trouble  —  that    of    a 


134  CARE  AND    TREATMENT  OF  EPILEPTICS. 

young  woman  who  died  of  consumption  from  which  she 
was  suffering  when  brought  to  the  community.  Of  the 
twenty-three  persons  who  died  at  the  colony  during  the 
period  named,  four  were  between  the  ages  of  sixty  and  sev- 
enty, three  between  seventy  and  seventy-five,  four  between 
seventy-five  and  eighty,  five  between  eighty  and  eighty- 
five,  and  four  between  eighty-five  and  eighty-seven. 

On  the  third  anniversary  of  the  opening  of  the  colony, 
January  27,  1899,  it  contained  353  patients,  of  whom  163 
were  males  and  190  were  females.  Of  the  female  cases,  33 
were  girls  under  sixteen  years  of  age,  and  of  the  male  cases, 
20  were  boys  under  sixteen  years  of  age.  These  figures 
include  6  male  patients  and  9  female  patients  in  the  hos- 
pital. The  number  admitted  to  the  colony  between  its 
opening,  January  27,  1896,  and  January  27,  1899,  was  455» 
of  whom  232  were  males  and  223  were  females.  During 
this  period  there  were  discharged  102,  as  follows: 

Recovered 7 

Improved 40 

Unimproved 17 

Insane 12 

Died 26 

The  12  insane  patients,  4  of  whom  were  insane  when 
they  entered  the  colony,  were  transferred  to  the  State 
hospitals  in  the  districts  from  which  they  were  committed 
to  the  colony. 

The  present  capacity  of  the  institution  is  for  360  patients. 
When  the  new  group  of  buildings  for  women  and  children 
is  completed  it  will  accommodate  620  patients. 

The  total  amount  appropriated  for  improvements  previous 
to  1899,  including  the  appropriations  for  the  water-supply 
and  sewerage  systems,  was  $425,000. 

Aside  from  maintenance,  the  Legislature  of  1899  appropri- 


CRAIG   COLONY.  135 

ated  for  improvements  $105,000.  This  sum  includes  $65,000 
to  be  expended  in  erecting  buildings  for  patients,  two  cot- 
tages for  employees,  a  warehouse  with  facilities  for  the 
cold  storage  of  provisions  and  for  baking  ;  in  making  an 
extension  to  the  industrial  building  and  its  machinery,  also 
to  the  sewerage  plant  ;  and  in  improving  the  grounds. 

In  establishing  the  colony  there  has  been  expended  not 
a  little  self-sacrificing  effort  by  many  whose  names  do  not 
appear  in  these  pages.  Among  them,  and  deserving  of 
special  mention,  is  Mrs.  Charles  F.  Wadsworth,  chairman 
of  the  first  executive  committee. 

Considering  the  advantages  possessed  by  the  colony  for 
accomplishing  the  object  for  which  it  was  founded, — advan- 
tages which  include  a  large  tract  of  fertile  land,  a  healthful 
situation  in  a  temperate  climate,  an  abundant  water-supply, 
numerous  comfortable  dwellings  of  moderate  size  in  widely 
distributed  groups,  the  substructure  of  wise  statutes  by 
which  it  is  operated,  and  the  liberal  spirit  in  which  the 
people  have  met  the  demands  for  its  improvement, — it  may 
not  be  regarded  as  an  optimistic  view  to  see  in  its  future 
development  a  grand  and  beneficent  charity. 


CHAPTER   IV. 

MASSACHUSETTS,  NEW  JERSEY,  TEXAS. 


MASSACHUSETTS. 

IN  Massachusetts,  as  in  Ohio  and  New  York,  the  establish- 
ment of  a  State  institution  for  epileptics  was  preceded 
by  an  earnest  effort  of  benevolent  persons  in  their  behalf. 
In  December,  1890,  Dr.  William  N.  Bullard  read  before  a 
section  of  the  Massachusetts  Medical  Society  a  paper  on 
"  Provision  for  the  Care  of  Adult  Pauper  Epileptics  in 
Massachusetts,"  in  which  he  directed  attention  to  the  total 
lack  of  proper  provision  for  this  class.  The  following  is  an 
excerpt  from  Dr.  Bullard's  able  paper: 

"  Out  of  the  many  thousand  pauper  patients  who,  in 
the  course  of  a  year,  seek  treatment  in  our  large  hospitals 
and  charitable  medical  institutions,  there  is  no  class  for 
whose  proper  care  and  protection  the  means  at  our  disposal 
are  so  utterly  inadequate  as  for  adult  pauper  epileptics. 
Beyond  certain  mild  palliative  therapeutic  measures,  we 
have  no  resource  until  the  patients  become  fit  subjects  to 
be  legally  committed  to  institutions  for  the  insane.  The 
only  exceptions  are  those  cases  where  surgical  interference 
is  deemed  desirable.  In  the  whole  range  of  medical  practice 
in  Massachusetts,  there  is  no  class  of  patients  whose  interests 
have  been  so  thoroughly  neglected. 

"  There  is  probably  no  considerable  class  of  the  physically 
or  mentally  afflicted  which  contains  so  large  a  proportion 
of  persons  demanding   our   deepest    sympathy,    or   which 

136 


MA  SSA  CH  USE  TTS.  1 3  7 

entails  so  large  an  amount  of  suffering  for  each  person,  as 
that  comprising  the  chronic  epileptics.  They  are,  as  a 
whole,  much  worse  off  than  the  chronic  insane,  worse  off 
even  than  the  acute  insane,  for  the  condition  of  the  latter 
is  but  temporary.  The  chronic  epileptic  is,  however,  in  a 
condition  which  may  be  described  as  one  of  recurrent  in- 
sanity. The  attacks  are  not  so  distressing  in  themselves. 
During  them,  the  patient  is  unconscious;  but  the  condition 
preceding  is  often  one  of  much  mental  pain,  and  it  is  the 
constant  dread  of  the  attack,  always  impending,  occurring 
at  any  time  without  notice,  which  causes  the  greatest  strain. 
There  is  also  the  mental  condition  of  depression  and  of  un- 
controllable fear  and  terror  produced  by  the  disease  itself, 
which  adds  to  its  horrors." 

Dr.  Bullard  was  requested  to  bring  the  subject  before  the 
State  Medical  Society  at  its  annual  meeting.  This  led  to 
the  appointment  of  a  committee  by  the  State  Society  to 
present  the  matter  to  the  Legislature  and  to  have  general 
charge  of  the  project  for  securing  State  provision  for 
epileptics. 

In  February,  1892,  the  Governor  of  Massachusetts  sent 
the  following  message  to  the  Legislature : 

"  I  herewith  submit  for  your  consideration  a  report  made 
to  me  by  an  able  committee  of  experts  of  the  Massachusetts 
Medical  Society,  submitting  in  detail  the  reasons  which,  in 
their  judgment,  make  it  necessary  for  the  Commonwealth 
to  provide  for  the  establishment  of  an  institution  for  epilep- 
tics,— such  institution  to  be  in  the  form  of  cottage  hospitals. 
This  committee  has  been  given  full  power  to  act  in  the 
matter  for  said  society,  and  their  recommendation,  I  believe, 
meets  its  approval. 

'  I  have  referred  it  to  the  State  Board  of  Lunacy  and 
Charity,  with  a  request  for  their  opinion  upon  it.     I  herewith 


138  CARE   AND  TREATMENT   OF  EPILEPTICS. 

submit  their  opinion,  in  writing,  endorsing  the  recom- 
mendation. In  my  judgment,  the  facts  and  reasons  stated 
in  this  communication  entitle  the  recommendation  to  your 
early  and  favorable  action.  I  specially  commend  the  sug- 
gestion that  the  hospital,  if  established,  should  be  in  the 
form  of  cottage  hospitals." 

The  Legislature  gave  the  subject  some  consideration,  but 
referred  it  to  the  next  General  Court.  In  its  Report  to  the 
Legislature,  December  17,  1892,  the  Board  of  Lunacy  and 
Charity  directed  attention  to  the  subject  in  the  following 
language : 

"  The  matter  is  one  that  demands  prompt  action.  The 
number  of  these  unfortunates  is  constantly  increasing 
among  us,  and,  while  almost  every  other  class  of  the  sick, 
the  poor,  and  the  afflicted  are  provided  for,  no  special 
arrangement  is  made  for  adult  epileptics,  and  their  only 
refuge  seems  to  be  the  insane  hospitals,  in  whose  crowded 
wards  they  are  wholly  out  of  place,  or  the  town  almshouses, 
where  their  only  prospect  is  increased  suffering  and  gradual 
decay.  ...  It  would  seem  wise  and  just  that  the 
State,  always  ready  to  relieve  suffering,  should  take  some 
measures  for  the  protection  and  relief  of  its  epileptics,  and 
the  Board  would  earnestly  recommend  speedy  action  in  the 
matter." 

The  Board  repeated  its  recommendation  in  its  Report 
made  December  28,  1893  ;  and  in  its  Report  for  1894  it  said  : 

"  The  Board  once  more  earnestly  recommends  that  the 
first  steps  be  taken,  without  further  delay,  towards  the 
establishment  of  a  hospital  for  the  custody  and  relief  of 
epileptics.  The  recommendation  has  the  unqualified  en- 
dorsement of  the  leading  physicians  of  the  State." 

Finally  the  Legislature  passed  an  act,  Chapter  483,  Laws 
of  1895,  establishing  a  special  hospital  for  epileptics. 


MASSACHUSETTS.  1 39 

MASSACHUSETTS    HOSPITAL    FOR    EPILEPTICS. 

The  act  referred  to,  creating  this  institution,  assigned  to 
the  use  of  the  hospital  all  the  lands,  buildings,  and  personal 
property  formerly  belonging  to  the  State  Primary  School  at 
Monson,  and  appropriated  $160,000  for  alterations  and 
additions  to  the  existing  buildings  and  the  erection  of  such 
new  ones  as  should  be  deemed  necessary  for  the  accommo- 
dation of  two  hundred  patients  and  the  physicians  and 
other  officers  and  attendants  who  should  have  the  care  of 
the  patients. 

The  government  is  vested  in  a  Board  of  seven  trustees 
appointed  by  the  Governor,  two  of  whom  are  women. 
Upon  this  body  are  conferred  the  same  general  powers  as 
are  possessed  by  the  trustees  of  the  State  lunatic  hospitals. 
The  Board  is  empowered  to  appoint  the  head  physician, 
assistant  physicians,  and  such  other  officers  and  agents  as  it 
may  deem  necessary.  These  hold  their  positions  at  the 
pleasure  of  the  Board,  their  salaries  being  subject  to  the  ap- 
proval of  the  Governor  and  his  Council.  The  trustees  re- 
ceive no  compensation  except  for  expenses  incurred. 

In  respect  to  the  admission  and  support  of  patients  the 
act  authorizes  the  reception  into  the  hospital  for  care  and 
treatment  of  "  any  adult  person,  not  a  criminal,  who  is  sub- 
ject to  epilepsy,  provided  such  person  be  neither  an  idiot, 
an  inebriate,  nor  violently  insane." 

The  statutes  that  apply  to  the  State  lunatic  hospitals  re- 
garding the  commitment,  detention,  transfer,  and  discharge 
of  insane  patients  are  made  applicable  to  the  Hospital  for 
Epileptics,  and  insane  epileptics  may  be  committed  to  the 
latter,  provided  they  belong  to  the  class  above  specified. 

The  act  provides  that  "  the  trustees  of  said  hospital  may 
receive  and  detain  therein,  as  a  boarder  and  patient,  any 
person  subject  to  epilepsy  who  is  desirous  of  submitting 


140  CARE   AND    TREATMENT  OF  EPILEPTICS. 

himself  for  treatment  and  makes  written  application  there- 
for, but  whose  mental  condition  is  not  such  as  to  render  it 
legal  to  grant  a  certificate  of  insanity  in  his  case.  No  such 
person  shall  be  detained  for  more  than  three  months  after 
having  given  written  notice  of  his  intention  or  desire  to  leave 
said  hospital.  When  any  patient  is  received  at  said  hospital 
the  superintendent  shall  report  the  particulars  of  the  case  to 
the  State  Board  of  Lunacy  and  Charity,  which  may  investi- 
gate the  same." 

The  act  also  provides  that  all  epileptics  of  the  class  first 
named  may  be  transferred  from  any  lunatic  hospital  by  the 
Board  of  Lunacy  and  Charity  to  the  Massachusetts  Hospi- 
tal for  Epileptics,  "  and  when  said  Board  has  reason  to  be- 
lieve that  any  such  epileptic  confined  in  any  almshouse  or 
other  place  is  deprived  of  proper  treatment  or  care,  whether 
such  epileptic  is  a  public  charge  or  otherwise,  it  may  cause 
the  transfer  or  commitment  of  such  person  to  the  Massa- 
chusetts Hospital  for  Epileptics ;  and  said  State  Board  shall 
transfer  from  said  Hospital  for  Epileptics  to  some  State 
lunatic  hospital  or  asylum  such  inmates  as  may  be  found  to 
be  violently  insane  and  requiring  treatment  therein." 

The  charges  for  the  support  of  inmates  able  to  pay,  or 
such  as  have  kindred  or  others  bound  by  law  to  maintain 
them,  must  be  paid  by  such  inmates  or  such  kindred  or 
others  legally  beholden,  at  a  rate  determined  by  the  trus- 
tees. The  charges  for  the  support  of  other  patients  having 
legal  settlements  in  the  State  must  be  paid  by  the  authori- 
ties of  the  place  of  settlement ;  and  those  having  no  legal 
settlement  in  the  State  are  paid  for  by  the  State  at  the  same 
rate  as  is  paid  for  the  support  of  city,  town,  and  State 
patients  in  the  State  hospitals  for  the  insane. 

The  buildings  of  the  institution  occupy  a  beautiful  site 
shaded  by  an  old  growth  of  elms  and  maples.     The  estate 


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MASSACHUSETTS  HOSPITAL  FOR  EPILEPTICS.       141 

comprises  237  acres,  about  one  half  of  which  is  tillable. 
The  remainder  is  pasture  and  woodland.  There  are  about 
five  acres  of  orchard. 

Most  of  the  old  buildings  could  not  be  utilized  for  hospital 
purposes,  and  were  torn  down  and  removed.  Five  of  the 
smaller  ones,  in  addition  to  the  barns,  were  preserved  for 
future  use.  The  boiler-house,  laundry  building,  and  car- 
penter's shop  were  converted  into  heating  and  electric-light 
plants,  laundry,  bakery,  storerooms,  and  workshops;  the 
larger  hospital  building  was  arranged  for  the  accommodation 
of  general  employees,  and  the  smaller  one  for  patients.  In 
addition,  two  hospitals  and  a  new  administration  building 
of  brick  have  been  erected. 

The  administration  building  is  50x60  feet,  and  three 
stories  high.  The  first  floor  is  occupied  by  offices  and  other 
public  rooms.  The  two  upper  stories  provide  apartments 
for  the  medical  staff  and  some  other  officers. 

The  two  hospital  buildings,  one  for  men  and  the  other 
for  women,  are  alike — two  stories  high,  each  building  com- 
plete in  itself,  with  kitchen,  dining-  and  living-rooms.  Their 
general  shape  is  that  of  a  rectangle,  50  x  125  feet,  with  an  L 
30  x  30  feet  projecting  from  the  north  side  at  either  end. 
In  the  southeast  and  southwest  corners  of  each  story  are 
day-rooms,  between  which,  on  the  south,  are  two  large 
dormitories.  On  the  north  are  two  dining-rooms  separated 
by  a  serving-room.  In  each  L  at  the  rear  of  the  day-room 
are  four  bedrooms,  and  bath-,  toilet-,  and  clothes-rooms. 
The  second  story  is  a  counterpart  of  the  first.  The  ground 
slopes  to  the  north,  admitting  of  a  basement  on  that  side, 
which  is  used  for  kitchen  purposes.  Each  building  is 
divided  into  four  distinct  sections,  accommodating  twenty- 
five  patients  each. 

To  supply  water,  a  new  covered  reservoir,  which  holds 


142  CARE  AND    TREATMENT  OF  EPILEPTICS. 

178,000  gallons,  has  been  built  of  masonry  on  the  high  land 
west  of  the  institution,  into  which  water  from  the  Monson 
town  system  flows  by  gravity.  This  affords  an  excellent 
and  abundant  supply  for  all  requirements. 

The  sewage  is  distributed  on  the  sloping  ground  at  the 
north  when  needed  for  fertilization,  and  at  other  times 
passes  farther  along  to  the  filtration  area,  which  is  com- 
posed of  coarse  gravel. 

It  will  be  noticed  that  the  Massachusetts  law  requires 
that  insane  epileptics  of  a  mild  class,  as  well  as  the  sane, 
shall  be  received  at  the  hospital.  It  was  deemed  necessary 
by  the  trustees  to  provide  for  custodial  care  of  patients  in 
the  present  group  of  buildings.  For  such  sane  epileptics 
as  will  be  able  to  live  under  the  conditions  to  be  found  in 
the  ordinary  village  community,  it  is  proposed  to  erect,  at 
a  considerable  distance  from  the  present  buildings,  cottages 
similar  to  ordinary  dwellings. 

The  hospital  was  opened  for  the  reception  of  patients  by 
the  proclamation  of  the  Governor,  May  2,  1898.  On  Sep- 
tember 30,  1898,  there  were  200  inmates,  the  sexes  being 
about  equally  divided.  Of  this  number  58  were  sup- 
ported by  the  State,  134  by  towns,  and  8  were  private 
patients.  Ten  per  cent,  of  those  received  are  young  and 
teachable.  A  school  has  been  organized  for  elementary 
instruction  and  preparation  for  manual  training.  It  is  in- 
tended to  teach  carpentry,  painting,  shoemaking,  tailoring, 
and  other  handicrafts.  Twenty-four  of  the  more  demented 
men  have  been  employed  in  grading  and  making  roads; 
others  have  worked  on  the  farm,  in  the  laundry,  and 
in  and  about  the  kitchens,  making  fifty-three  per  cent, 
working  outside  the  wards.  Thirteen  of  the  men  patients 
have  assisted  in  the  wards.  Thirty-four  per  cent,  of  the 
whole  number  are  helpless,  feeble,  and  crippled. 


HOSPITAL   COTTAGES  FOR    CHILDREN.  1 43 

Thirty-eight  per  cent,  of  the  women  have  been  employed 
in  the  kitchen,  laundry,  sewing-rooms,  and  about  the  ad- 
ministration building;  seventeen  of  their  number  have 
helped  in  the  wards.  Thirty-six  per  cent,  are  helpless, 
crippled,  and  feeble. 

This  institution,  under  the  superintendency  of  Dr.  Owen 
Copp,  formerly  first  assistant  physician  in  the  Taunton 
Lunatic  Hospital,  has  made  a  very  creditable  showing,  and 
promises  to  occupy  a  large  field  of  usefulness  in  the  future. 
Its  scope  embraces  the  education,  employment,  and  recrea- 
tion of  its  beneficiaries.  The  scientific  study  of  epilepsy, 
for  which  it  is  expected  ample  facilities  will  be  provided, 
will  form  an  important  department.  The  capacity  of  the 
hospital  is  not  equal  to  the  demand  for  admission. 

HOSPITAL    COTTAGES    FOR    CHILDREN    AT    BALDWINVILLE. 

This  interesting  institution,  the  first  of  its  kind  in  this 
country,  having  for  its  special  object  the  treatment  of  epi- 
leptic children  under  State  auspices,  has  been  developed  on 
the  cottage  plan,  and  accommodates  130  children  of  both 
sexes.  There  are  received  here  children  under  fourteen 
years  suffering  from  epileptic  or  epileptiform  seizures; 
children  afflicted  with  other  nervous  diseases,  who  are  not 
feeble-minded  ;  and  deformed  children.  About  seventy  per 
cent,  of  the  inmates  are  epileptics.  Upwards  of  a  thousand 
children  have  been  treated  since  the  opening  of  the  institu- 
tion in  1882.  It  is  owned  by  a  private  benevolent  corpora- 
tion. In  1887  the  Legislature  appropriated  $10,000  to  pay 
existing  debts,  obtain  a  water-supply,  and  defray  running 
expenses.  In  1889,  $55,000  were  appropriated  by  the  Leg- 
islature for  the  construction  of  new  buildings;  and  in 
1890  the  sum  of  $30,000  was  added  to  the  grant,  for  the 
completion  of  the  work,  upon  the  condition  that  a  majority  of 


144  CARE  AND    TREATMENT  OF  EPILEPTICS. 

the  trustees  should  be  appointed  by  the  Governor.  The 
law  was  afterwards  changed,  so  that  the  hospital  now  has 
a  Board  of  five  trustees  appointed  by  the  Governor  and  a 
co-operating  Board  of  sixteen  elected  by  the  corporation. 

The  institution  is  under  the  immediate  charge  of  Dr. 
Everett  Flood,  who  is  assisted  by  a  staff  of  specialists  in  the 
various  medical  and  surgical  branches  of  the  hospital.  The 
total  force  of  employees  numbers  thirty-four.  The  average 
weekly  per  capita  cost  of  maintenance  for  the  fiscal  year 
ending  September  30,  1898,  is  given  as  $4. 19.  The  receipts 
for  board  were  $20,023.45,  and  from  donations,  $16,767.85. 
The  expenditure  for  salaries  was  $10,985.26.  Ten  per 
cent,  of  the  inmates  are  State  patients.  Those  from  other 
States  are  admitted  on  a  vote  of  the  medical  staff.  A  free 
bed  is  provided  for  $200  a  year;  a  permanent  free  bed  for 
$5000.  The  permanent  fund  amounts  tp  about  $60,000. 
There  is  published  in  connection  with  the  institution  a 
monthly  periodical  called  the  Hospital  Cottage  Friend. 

Quarterly  meetings  of  the  trustees  are  held  in  rotation  in 
different  parts  of  the  State,  an  arrangement  which  stimu- 
lates public  interest  over  a  wide  area.  With  the  aid  and 
co-operation  of  various  philanthropic  organizations  through- 
out the  State,  the  institution  has  accomplished  most  benefi- 
cent work. 

Subordinate  to  the  Board  of  Trustees  there  is  a  Woman's 
Board,  whose  members  meet  in  different  localities,  and 
assist  in  raising  means  for  the  hospital  and  otherwise  co- 
operate in  its  work.  Under  the  direction  of  the  Woman's 
Board  there  is  organized  a  Children's  League,  composed  of 
little  folks,  who  are  encouraged  to  contribute  small  sums, 
and  thus  extend  their  sympathy  to  the  hospital  sufferers. 

Occupation  and  schooling  are  deemed  remedial  measures. 
Dr.  Flood  says  he  could  hardly  dispense  with  this  kind  of 


HOSPITAL    COTTAGES    I  Baldwinville). 


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SCHOOLHOUSE   'Baldwinville'. 


NE W  JERSEY.  145 

treatment.  The  old  plan  of  entire  cessation  from  school 
work  and  absolute  unrestraint  is  no  longer  favored.  Out 
of  150  epileptic  cases  treated  in  nine  years  the  following 
results  are  given:  Recoveries,  25;  very  much  improved  by 
care,  44;  improved  somewhat,  52;  not  improved,  6;  died, 
18;  became  insane,  5. 

The  Superintendent  says  that  14  of  the  25  patients  classed 
as  recovered,  though  still  free  from  spasms,  have  defects 
which  prevent  them  from  being  self-supporting,  and  they 
must  to  a  large  extent  be  cared  for  by  others.  Eleven  of 
the  children,  however,  are  bright  and  active,  and  are  said 
to  give  promise  of  being  for  the  rest  of  their  lives  useful 
and  independent  citizens. 

The  farm  in  connection  with  the  institution  comprises 
about  two  hundred  acres  of  woodland  and  pasture-land, 
with  an  abundance  of  wild  berries  on  the  estate. 

NEW   JERSEY. 

For  a  number  of  years  attention  has  been  directed  by 
prominent  citizens  of  New  Jersey  to  the  need  of  suitable  pro- 
vision for  epileptics  in  that  State.  The  recognized  leader  in 
the  movement  to  ameliorate  their  condition  was  Prof.  S. 
Olin  Garrison,  to  whose  indefatigable  efforts  the  progress 
made  must  be  mainly  ascribed. 

In  accordance  with  a  resolution  of  the  Legislature  of  New 
Jersey  passed  in  1895,  the  Governor  appointed  a  commission 
of  five  persons,  of  which  Dr.  P.  C.  Barker  was  made  chair- 
man, and  Professor  Garrison  secretary,  to  make  an  investi- 
gation into  the  number  and  condition  of  the  epileptics  in 
the  State  and  report  thereon  to  the  Legislature.  The  com- 
missioners addressed  circulars  of  inquiry  to  upwards  of  two 
thousand  physicians  and  one  hundred  institutions  in  the 
State,  and  received  replies  from  about  four  hundred  of  the 


146  CARE  AND  TREATMENT  OF  EPILEPTICS. 

former  and  about  forty  of  the  latter.  Altogether,  1060 
cases  were  reported  upon — 709  by  the  physicians  and  351 
by  the  institutions.  From  the  inquiries  made  the  conclu- 
sion was  reached  that  the  total  epileptic  population  of  the 
State  was  more  than  two  thousand.  In  the  two  State  hos- 
pitals for  the  insane  there  were  168  cases;  and  the  commis- 
sion reported  that  it  had  been  found  impossible  to  classify 
epileptics  in  these  institutions,  and  that,  in  the  opinion  of 
the  medical  directors  of  the  hospitals,  the  presence  of  epi- 
leptics and  insane  persons  in  the  same  institution  was 
injurious  to  both.  Moreover,  it  was  shown  that  a  consider- 
able number  of  the  former  were  sane. 

The  report  of  the  commission  was  a  comprehensive  and 
forcible  document.  It  urgently  recommended  legislation 
which  would  open  the  way  for  the  removal  of  epileptics 
from  the  almshouses  and  homes  of  the  poor  and  place 
them  in  a  special  colony  or  village  where  they  could 
receive  proper  treatment  and  be  subjected  to  the  cura- 
tive and  ameliorating  influences  which  experience  had  shown 
to  be  efficacious.  It  was  presented  to  the  Legislature  in 
1896,  and  a  bill  was  introduced  about  the  same  time  for 
the  establishment  of  a  colony  on  a  plan  recommended 
by  the  commission.  Coincident  with  the  presentation  of 
the  report  to  the  Legislature  the  commission  issued  cir- 
culars making  an  earnest  appeal  to  the  benevolently  dis- 
posed for  co-operation  in  an  attempt  to  secure  the  desired 
legislation.  The  bill  passed  both  branches  of  the  Legisla- 
ture, but  did  not  become  a  law,  failing  to  meet  the  approval 
of  the  Governor.  Subsequent  to  the  defeat  of  the  measure 
in  1896,  a  resolution  of  the  Allopathic  State  Medical  Society 
endorsed  the  necessity  for  such  legislation,  and  in  1897  the 
Society  reaffirmed  its  position,  and  appointed  a  committee 
to  urge  the  matter  further. 


NEW  JERSEY  STATE    VILLAGE.  1 47 

A  bill  for  the  establishment  of  an  institution  for  the 
special  care  of  epileptics,  introduced  in  the  Legislature  of 
1898,  was  passed  by  a  unanimous  vote  of  both  houses,  and 
promptly  approved  by  Governor  Voorhees.  The  "  Act  to 
establish  a  village  for  epileptics,"  Chapter  113,  Laws  of  1898, 
provides  that  a  Board  of  unsalaried  managers  consisting  of 
six  residents  of  the  State,  not  more  than  three  of  whom 
shall  be  members  of  the  same  political  party,  shall  be  ap- 
pointed by  the  Governor,  with  the  advice  and  consent  of 
the  Senate.  It  was  made  the  duty  of  the  managers  to  select 
a  site  for  an  epileptic  village  within  six  months  after  their 
appointment,  to  draft  general  rules  for  the  government  of 
the  village,  and  to  appoint  a  superintendent. 

The  managers  appointed  under  the  foregoing  act  selected 
a  location  at  Skillman,  Somerset  County,  one  and  a  quarter 
miles  from  the  main  line  of  the  Philadelphia  &  Reading 
Railway,  and  about  midway  between  New  York  and  Phila- 
delphia. The  site  purchased  contains  187  acres,  upon  which 
is  a  capacious  and  substantial  mansion.  The  estate  cost 
$11,500. 

By  "  An  Act  relative  to  the  government  and  management 
of  the  New  Jersey  State  Village  for  Epileptics,"  Chapter 
152,  Laws  of  1899,  the  powers  and  duties  of  the  managers 
and  leading  officers  of  the  colony  are  particularly  defined. 
The  act  provides  that  the  Board  of  Managers,  upon  the 
nomination  of  the  Superintendent,  who  is  required  to  be  a 
well-educated  physician,  shall  appoint  a  steward,  as  many 
assistant  physicians  as  may  be  necessary  to  carry  on  the 
work  of  the  colony,  and  a  matron.  These  officers  hold 
their  positions  at  the  pleasure  of  the  Board.  The  Superin- 
tendent is  recognized  as  the  chief  executive  officer  of  the 
colony. 

Indigent  patients  are  received   from   the  authorities  of 


148  CARE  AND  TREATMENT  OF  EPILEPTICS. 

different  counties  in  proportion  to  the  population  of  such 
counties.  Private  patients  ma)'  be  admitted  at  the  discre- 
tion of  the  managers. 

A  request  for  admission  to  the  colony  must  state  the  full 
name,  place  of  residence,  age,  place  of  nativity,  if  known, 
occupation,  etc.,  of  the  applicant,  and  the  degree  of  relation- 
ship between  himself  and  the  person  for  whom  he  seeks  ad- 
mission. It  must  be  accompanied  by  the  certificates  of  two 
physicians,  stating  that  the  person  who  desires  to  be  ad- 
mitted is  an  epileptic.  It  is  required  that  the  certificates  be 
given  under  oath  or  affirmation  within  thirty  days  imme- 
diately preceding  the  reception  of  the  patient  into  the  colony. 
The  physicians  giving  such  certificates  must  be  permanent 
residents  of  the  State,  who  have  graduated  at  some  regu- 
larly incorporated  medical  college,  and  have  been  in  the 
actual  practice  of  their  profession  for  at  least  three  years. 
The  certificates  and  other  forms  of  admission  must  be  in 
accordance  with  certain  specified  forms  adopted  by  the 
Board  of  Managers,  and  must  give  a  complete  history  of 
the  case,  and  the  cause,  nature,  and  progress  of  the  dis- 
ease, so  far  as  is  known.  In  the  case  of  a  person  main- 
tained at  private  expense,  in  addition  to  the  aforementioned 
requirements,  a  bond  for  the  support  of  the  patient  so  long 
as  he  shall  remain  in  the  colony  must  be  executed.  This 
is  drawn  in  favor  of  the  Treasurer  and  signed  by  two  sure- 
ties approved  by  the  Superintendent. 

It  is  required  that  patients  when  admitted  shall  be  in  a 
state  of  bodily  cleanliness,  shall  be  comfortably  clothed,  and 
provided  with  suitable  raiment,  as  prescribed  by  the  Board 
of  Managers,  and  shall  not  have  been  exposed  to,  or  be 
suffering  from,  any  contagious  disease.  No  child  under 
five  years  of  age  is  allowed  to  be  admitted. 

For  the  purpose  of  preserving  and  maintaining  order  and 


TEXAS.  149 

preventing  disturbances  and  trespassing  on  the  lands  of  the 
colony,  the  managers  are  given  police  jurisdiction  within  the 
grounds  and  for  two  miles  beyond  its  boundaries. 

The  sale,  directly  or  indirectly,  of  any  spirituous,  malt, 
vinous,  or  intoxicating  liquors  or  beverages,  or  any  com- 
position of  which  said  beverages  or  any  of  them  shall  be  the 
chief  ingredient,  within  two  miles  of  the  boundaries  of  the 
colony,  is  made  a  misdemeanor,  and  is  punishable  by  a  fine 
or  imprisonment  or  both. 

An  appropriation  of  $25,000  was  made  by  the  Legislature 
of  1899  for  the  erection  of  two  brick  cottages,  and  $8000 
to  buy  additional  land  adjoining  the  property  already 
purchased,  it  having  been  found  that  the  acreage  originally 
secured  was  insufficient  for  the  proper  development  of 
the  colony.  An  appropriation  was  also  made  for  supplying 
water,  for  sewerage  purposes,  for  salaries  of  officers,  and 
making  necessary  repairs. 

The  plan  of  the  founders  as  suggested  in  the  term  "  epi- 
leptic village,"  which  implies  extended  classification  in  in- 
expensive buildings,  it  is  hoped  may  be  carried  out.  The 
President  of  the  recently  appointed  Board  of  Managers, 
Rev.  James  M.  Buckley,  LL.D.,  and  the  Secretary  of  the 
Board,  Professor  Garrison,  both  strongly  favor  the  village 
or  colony  plan. 

TEXAS. 

A  paper  by  Dr.  F.  S.  White  in  advocacy  of  the  colony 
plan  for  the  care  of  epileptics  was  read  before  the  State 
Medical  Association  in  1896.  It  was  published  in  the 
Transactions  of  the  Association  for  that  year  and  created 
public  discussion  and  favorable  comment.  A  committee, 
of  which  Dr.  White  was  made  chairman,  was  appointed  by 
the  Association  to  present  the  subject  to  the  Legislature. 


150  CARE  AND  TREATMENT  OF  EPILEPTICS. 

Some  action  was  taken  by  the  Senate  looking  to  the  exclu- 
sion of  epileptics  from  insane  hospitals,  with  the  ultimate 
aim  of  making  separate  provision  for  them;  but  no  legisla- 
tion was  consummated. 

The  benevolent  efforts  of  Dr.  White  and  others  interested 
in  the  welfare  of  these  sufferers  were  not  destined,  however, 
to  be  lost.  In  his  last  Annual  Message  the  Governor  of  the 
State  directed  the  attention  of  the  Legislature  to  the  neces- 
sity of  making  suitable  provision  for  this  class,  and  an  act 
was  passed  providing  for  the  establishing  of  an  epileptic 
colony  and  appropriating  $50,000  therefor.  The  act  au- 
thorizes the  appointment  by  the  Governor  of  three  com- 
missioners to  select  the  site,  which  shall  be  approved  by 
him.  It  also  provides  for  the  subsequent  appointment 
by  the  Governor  of  a  Board  of  Managers,  who  shall  be 
entrusted  with  the  erection  of  the  buildings  and  the  man- 
agement of  the  colony.  It  is  further  provided  that  the 
epileptic  insane  now  confined  in  the  several  asylums  of 
the  State  "  be  transferred  to  the  colony,  and  that  such 
others  as  may  from  time  to  time  be  declared  epileptic 
lunatics  of  the  State,  under  such  rules  and  regulations  as 
are  now  or  may  hereafter  be  provided  by  law,  shall  be 
confined  and  treated  in  said  colony."  The  act  concludes 
with  the  following  clause:  "  Whereas,  there  is  now  a  large 
number  of  insane  persons  in  the  jails  throughout  the 
State  who  are  much  in  need  of  immediate  treatment;  and, 
whereas,  there  is  a  large  number  of  epileptic  insane  in  the 
several  asylums  of  the  State  who  are  in  great  need  of  sepa- 
ration from  the  other  insane  of  the  several  asylums;  and, 
whereas,  there  is  now  a  large  number  of  epileptic  insane 
throughout  the  State  who  are  in  great  need  of  care  and 
treatment,  who  cannot  be  admitted  into  the  several  asylums 
on  account  of  their  incurable  condition  and  the  crowded 


TEXAS.  151 

condition  of  said  asylums:  therefore,  a  public  emergency 
and  imperative  public  necessity  exist,  which  render  it  neces- 
sary that  the  constitutional  rule  requiring  bills  to  be  read 
on  three  several  days  be  suspended,  and  that  this  act  take 
effect  and  be  in  force  from  and  after  its  passage;  and  it  is 
so  enacted." 

The  Governor  appointed  a  commission  to  carry  into  effect 
the  purposes  of  the  act,  and  it  has  accepted  from  the  city 
of  Abilene  a  site  of  640  acres  for  the  colony.  Dr.  B.  M. 
Worsham,  Superintendent  of  the  State  Lunatic  Asylum  at 
Austin,  is  a  member  of  this  commission,  and  since  his  ap- 
pointment he  has  visited,  among  other  institutions  for  epi- 
leptics, the  Craig  Colony,  the  Massachusetts  Hospital  for 
Epileptics,  and  the  Pennsylvania  Colony  Farm,  with  a  view 
to  preparing  plans  for  the  development  of  the  colony. 


CHAPTER   V. 
PENNSYLVANIA,   MARYLAND,  MISSOURI. 


PENNSYLVANIA. 

THE  Lunacy  Committee  of  the  Board  of  Public  Charities 
of  Pennsylvania  in  its  report  for  1893  made  mention 
of  the  fact  that  575  epileptics  were  detained  in  the  various 
institutions  of  that  State  under  the  lunacy  law.  The  report 
contained  a  strong  plea  for  the  establishment  of  a  State  in- 
stitution exclusively  for  epileptics,  to  be  conducted  on  an 
industrial  basis.  The  Board  of  Public  Charities  in  1895  re- 
newed this  plea.  The  same  year  Secretary  Biddle  in  his 
report  to  the  Board  said:  "  More  frequently  than  ever  has 
my  attention  been  called  during  the  past  year  to  the  neces- 
sity for  the  erection  of  an  institution  in  Pennsylvania  de- 
voted to  the  care  of  epileptics.  .  .  .  Special  appliances 
in  a  special  environment  are  necessary  for  the  treatment  of 
this  peculiar  form  of  disease.  So  long  as  Pennsylvania  pro- 
vides no  such  institution  she  will  be  derelict  in  her  duty  to 
a  large  number  of  her  citizens  who  have  a  rignt  to  demand 
it." 

A  bill  providing  for  the  erection  of  a  State  hospital  for 
epileptics,  prepared  by  the  Lunacy  Committee,  was  intro- 
duced in  the  Legislature  of  1897,  but  failed  to  become  a 
law.  In  again  urging  the  establishment  by  the  State  of  a 
special  institution  for  this  class  the  committee  presented 
forcible  reasons  for  such  action.     Among  others  given  were 

152 


PENNSYLVANIA   HOSPITAL  AND    COLONY  FARM.       1 53 

the  following:  "  The  medical  treatment  of  epilepsy  has 
been  unsatisfactory  and  discouraging,  mainly  because  we 
have  had  no  State  institution  organized  and  especially 
equipped  for  a  scientific  study  of  the  various  forms  and 
various  conditions  and  causes  of  this  disease  and  its  many 
complications.  The  truly  scientific  study  of  epilepsy  is  a 
wide  and  as  yet  untilled  field  in  our  State  and  country. 
Even  in  our  State  hospitals,  the  large  number  of  inmates, 
the  unfavorable  conditions  for  treating  epilepsy  in  a  mixed 
class  of  the  insane,  and  the  amount  of  other  medical  work 
on  hand,  render  anything  like  a  true  study  and  special 
observation  and  treatment  of  epilepsy  a  physical  impossi- 
bility. A  very  large  proportion  of  the  epileptics,  whether  in 
our  State  hospitals  and  almshouses  or  in  the  community, 
would  be  able  to  be  usefully  and  profitably  employed  if 
segregated  in  a  quiet  community,  properly  classified,  in  a 
wholesome  country  air,  free  from  anxiety,  poverty,  noise, 
and  excitement,  and  under  special  medical  treatment. 
Farming,  gardening,  horticulture,  domestic  work,  carpen- 
tering, and  a  variety  of  mechanical  arts  are  well  adapted  to 
the  condition  and  ability  of  the  average  epileptic,  who 
would  thus  be  able  to  contribute  very  largely  to  the  cost  of 
his  maintenance,  if  placed  in  an  appropriate  institution." 

THE    PENNSYLVANIA    EPILEPTIC    HOSPITAL    AND    COLONY    FARM. 

This  institution  is  a  private  corporation  controlled  and 
directed  by  a  Board  of  Managers,  assisted  by  a  Ladies'  Aid 
Committee.  It  is  supported  by  private  contributions  and 
the  State. 

The  Colony  Farm  is  situated  at  Oakbourne,  twenty-two 
miles  from  Philadelphia  and  two  miles  from  Westchester, 
in  a  section  of  highly  improved  farming  country.  The  farm 
consists  of  no  acres  of  productive  land,  and,  with  the  stone 


154  CARE  AND  TREATMENT  OF  EPILEPTICS. 

farmhouse,  a  large  and  well-arranged  barn,  a  dairy-house, 
and  other  buildings,  cost  $14,000.  The  estate  was  the  gift 
of  Miss  Rebecca  Coxe  and  Mr.  Eckley  B.  Coxe,  Jr.,  each  of 
whom  contributed  $7000  to  this  laudable  object.  In  1896 
Mr.  Henry  C.  Lea  generously  supplied  the  means  to  erect 
on  this  property  an  administration  building  and  two  cot- 
tages. In  the  administration  building,  which  stands  be- 
tween the  two  cottages,  are  the  managers'  room,  the  offices 
and  rooms  of  the  Superintendent,  assistant  physicians,  and 
matron,  also  a  drug  dispensary,  bakery,  storerooms,  work- 
rooms for  patients,  and  a  kitchen. 

The  two  cottages — one  for  each  sex — are  attractive,  and 
have  associate  dormitories  with  from  two  to  six  beds, 
rooms  for  nurses,  bath-  and  toilet-rooms,  and  a  dining-room 
and  kitchen.  There  is  no  general  kitchen.  The  manage- 
ment prefers  that  each  cottage  shall  be  as  complete  as 
possible  in  its  domestic  arrangements. 

The  Colony  Farm  was  opened  for  the  reception  of  pa- 
tients February  3,  1898.  At  the  date  of  March  4,  1899,  it 
contained  thirty  patients — twelve  men  and  eighteen  women. 
The  staff  consisted  of  a  Superintendent,  Dr.  J.  F.  Edgerly, 
a  matron,  two  nurses,  two  night-attendants,  an  engineer, 
a  farmer  and  an  assistant,  a  night-watchman,  laundress, 
cook,  and  maid. 

A  branch  of  the  work  is  conducted  in  Philadelphia, 
corner  of  Cherry  and  Lambert  streets,  in  a  stone  edifice 
formerly  known  as  the  Pennsylvania  Hospital  for  Epilep- 
tics. This  has  accommodations  for  twenty  patients,  and  is 
used  as  a  reception-house  and  dispensary.  Experience 
demonstrated  that  the  work  of  the  Pennsylvania  Hospital 
could  not  be  made  successful  in  its  restricted  quarters. 
Farm  colony  life  having  been  deemed  essential,  by  mutual 
agreement  of  those  interested  the  work  was  consolidated 


PENNSYLVANIA   HOSPITAL  AND   COLONY  FARM.      1 55 

with  that  of  the  Colony  Farm  in  1896.  Since  that  time 
the  two  departments  of  the  institution  have  been  under  the 
direction  of  one  Board.  The  future  development  of  the 
charity  is  looked  for  at  the  Colony  Farm. 

The  requests  for  admission  far  exceed  the  capacity  of  the 
institution,  applications  coming  from  New  Jersey,  Dela- 
ware, and  Maryland. 

The  women  do  all  the  household  work  in  their  several 
departments  and  much  of  the  sewing.  They  enjoy  the  use 
of  a  well-filled  library,  and  music  is  a  prominent  feature  of 
entertainment. 

In  reference  to  the  assistance  rendered  by  the  Ladies' 
Aid  Committee  during  the  year,  Dr.  Morton,  the  Secretary 
of  the  Board  of  Managers,  says:  "  They  have  rendered  ex- 
cellent service,  and  by  frequent  personal  visits,  by  supplying 
materials  for  embroidery  and  fancy  sewing,  numerous  books, 
pamphlets,  and  games,  and  money  for  excursions  in  sum- 
mer, giving  standing  orders  for  ice-cream  once  a  week,  etc., 
they  have  promoted  the  happiness  and  contentment  of  most 
of  the  patients  who  have  been  under  our  care,  and  they 
have  thus  done  much  towards  their  relief." 

Dr.  Edgerly  says:  "  All  patients  admitted  to  the  colony 
receive  careful,  individual  attention.  The  sanitary  condi- 
tion is  as  perfect  as  modern  science  can  make  it ;  the  water- 
supply  is  abundant  and  absolutely  pure.  The  buildings 
are  thoroughly  ventilated,  heated  by  steam,  and  lighted 
by  electricity.  The  regular  exercise  out-of-doors,  regular 
hours  for  occupation,  recreation,  and  rest,  with  a  carefully 
prescribed  diet,  combined  with  medical  treatment  according 
to  individual  needs,  have  accomplished  much  during  the  last 
year. 

"  All  patients  now  at  the  colony  are  distinctly  improved 
in  physical  and  mental  health,  and  in  a  large  majority  there 


156  CARE  AND  TREATMENT  OF  EPILEPTICS. 

is  a  marked  reduction  in  the  number  and  severity  of  attacks. 
Patients  have  been  received  and  treated  from  fifteen  differ- 
ent counties  in  the  State  of  Pennsylvania.  Most  of  these 
have  been  a  charge  on  the  institution,  its  resources  having 
been  taxed  to  the  utmost  limit." 

In  speaking  of  the  financial  affairs  of  the  colony,  the 
President  of  the  Board  of  Managers,  Dr.  Wharton  Sinkler, 
says:  "  A  few  of  the  patients  pay  something,  but  of  the 
total  number  who  do  pay,  the  amount  is  less  than  fifty  per 
cent,  of  the  cost  of  maintaining  them.  The  Legislature  of 
1897-98  appropriated  $5000  per  annum  for  two  years,  but 
this  sum  has  covered  less  than  one  half  of  our  expenses. 
We  have  therefore  applied  to  the  present  Legislature  for  an 
increased  appropriation  for  the  next  two  years,  and  should 
this  be  granted,  we  shall  be  able  to  admit  many  more  pa- 
tients, and  extend  our  charity  largely." 

Many  philanthropists  in  Philadelphia  are  interested  in  this 
work.  It  occupies  a  sphere  of  great  usefulness,  and  the 
State  would  do  well  to  lend  the  colony  its  co-operation  and 
liberal  support. 

THE  PASSAVANT   MEMORIAL  HOMES  FOR   THE  CARE  OF  EPILEPTICS. 

The  founders  of  the  Bethel  Colony  at  Bielefeld  and  the 
projector  of  a  little  colony  recently  established  in  Western 
Pennsylvania  seem  to  have  been  actuated  by  the  same 
benevolent  spirit.  Dr.  W.  A.  Passavant,  a  Lutheran  clergy- 
man, for  many  years  held  in  hopeful  anticipation  the  found- 
ing of  a  home  for  epileptics,  and  treasured  religiously  small 
sums  of  money  from  time  to  time  committed  to  his  keeping 
to  aid  in  carrying  out  this  purpose;  but  a  life  spent  in 
ministering  to  the  wants  of  the  poor  and  needy  of  all  classes 
prevented  concentration  of  energy  upon  this  one  object,  and 
the  death  summons  came  before  the  project  had  assumed 


PASSAVANT  MEMORIAL  HOMES.  1 57 

tangible  form.  The  work,  however,  was  taken  up  by  others 
interested,  and,  in  response  to  appeals  made,  nearly  $2000 
were  added  to  the  amount  previously  collected.  No- 
vember 23,  1894,  seven  persons  came  together  for  the  pur- 
pose of  maturing  plans  for  founding  the  home.  The 
selection  of  a  site  for  the  proposed  institution  had  virtu- 
ally been  agreed  upon,  and  application  had  been  made  to 
Bielefeld  for  two  deaconesses  to  aid  in  its  management.  At 
this  meeting  necessary  committees  were  appointed,  each  of 
which  entered  upon  its  duties.  At  a  second  meeting  of  the 
contributors,  held  March  20,  1895,  a  permanent  organization 
was  established  by  electing  the  Rev.  W.  A.  Passavant,  Jr., 
president,  and  choosing  a  vice-president  and  a  secretary  and 
treasurer. 

On  the  6th  of  June,  1895,  the  first  anniversary  of  the 
burial  of  Dr.  Passavant,  the  Orphans'  Home,  pleasantly 
situated  on  the  slope  of  a  hill  overlooking  the  town  of 
Rochester  and  the  Beaver  Valley,  was  opened  and  dedi- 
cated as  a  Christian  home  for  epileptics.  The  property  of 
the  Orphans'  Home  consisted  of  sixty  acres  of  land,  three 
dwelling-houses,  two  of  which  are  of  brick,  a  farmer's  house, 
a  barn  and  other  outbuildings.  The  work  of  adapting  the 
Home  to  its  new  purpose  progressed  rapidly;  but  word 
came  from  Bielefeld  that  no  deaconesses  could  be  spared 
from  there,  as  nine  had  just  been  sent  to  another  institution. 
An  appeal  made  to  the  Mary  J.  Drexel  Motherhouse  in 
Philadelphia  resulted  no  more  favorably,  and  attention  was 
then  turned  to  the  Norwegian  Lutheran  Deaconess  Hospi- 
tal in  Chicago,  whence  two  efficient  persons,  Sister  Amalie 
and  Sister  Martha,  were  secured. 

The  object  of  "  The  Passavant  Memorial  Homes  for  the 
Care  of  Epileptics  "  as  defined  by  the  constitution  is  "  to 
provide  persons  afflicted  with  epilepsy  with  opportunity  for 


158  CARE  AND    TREATMENT  OF  EPILEPTICS. 

usefulness,  medical  treatment,  and  the  mental  and  spiritual 
benefits  of  a  thoroughly  Christian  colony  or  home."  The 
institution  accommodates  thirty-six  patients  without  crowd- 
ing the  family  houses.  Three  classes  of  patients  are  re- 
ceived from  Western  Pennsylvania  and  West  Virginia, 
precedence  being  given  to  the  former  district.  The  first 
class  are  charity  patients,  who  are  maintained  by  the  Homes ; 
the  second  class  are  persons  who  are  able  to  make  a  moderate 
return  for  their  care  and  treatment ;  and  the  third  class  are 
those  who  are  blessed  with  means  sufficient  to  render  an 
equivalent  for  the  benefits  received.  Insane  epileptics  are 
not  admitted  to  the  Homes,  and  if  insanity  develops  after  a 
patient  has  been  received  he  is  removed  by  his  friends  or  at 
the  discretion  of  the  Board  of  Trustees.  The  demands  are 
so  great  upon  the  charity  of  the  institution  from  the  dis- 
tricts for  which  it  is  intended  to  provide  that  non-paying 
patients  outside  of  these  districts  are  not  received.  The 
Homes  were  not  established  to  relieve  poorhouses  of  their 
county  charges,  but  to  help  epileptics  whose  condition  is 
hopeful,  to  regain  a  position  of  self-support  and  cheerful 
contentment. 

The  general  management  of  the  institution  is  vested  in 
twelve  trustees,  four  of  whom  must  be  Lutherans;  and  the 
constitution  provides  that  the  internal  affairs,  such  as  the  ap- 
pointment and  discharge  of  assistants  and  domestics,  the 
practical  arrangements  for  the  labor,  discipline,  and  comfort 
of  the  inmates,  and  the  order  and  times  of  religious  services, 
must  be  under  the  direction  of  deaconesses  of  the  Lutheran 
Church,  "  in  order  that  there  may  be  harmony  of  action  in 
the  Homes,  and  that  the  evangelical  spirit  of  him  whose 
name  it  bears  may  ever  be  preserved,  and  the  strong  in- 
fluence of  a  united  religious  life  may  be  maintained  in  the 
institution." 


PA  SSA  VANT  MEM  OR  I  A  L  HOME  S.  1 5  9 

Sisters  Amalie  and  Martha  having  resigned  July  1,  1897, 
and  returned  to  their  native  country  (Norway),  two  sisters 
from  the  Milwaukee  Deaconess  Motherhouse  were  secured 
to  take  their  places.  Sister  Catharine  Deutzer  is  in  charge, 
assisted  by  Sister  Lena  Rash.  Of  the  work  of  the  devoted 
sisters  the  trustees  say:  "  The  quiet  fidelity  to  duty  and 
the  happy  influence  of  these  young  deaconesses  in  this  un- 
tried and  most  difficult  of  all  departments  of  the  ministry 
of  mercy  are  beyond  praise.  Their  trials  and  discourage- 
ments need  be  known  only  to  God,  and  we  merely  mention 
them  to  bespeak  that  genuine  sympathy  and  prayerful  sup- 
port that  workers  in  such  surroundings  sorely  need  to  enable 
strength  to  hold  out  and  courage  to  endure." 

Rev.  J.  Ash,  recently  elected  Superintendent  of  the 
Homes,  took  charge  October  1,  1896.  Besides  ministering 
to  the  spiritual  wants  of  the  inmates,  he  has  directed  the 
numerous  improvements  made  about  the  place,  planned  the 
work  and  recreation  of  the  inmates,  carried  on  the  corre- 
spondence and  innumerable  business  details  of  the  institu- 
tion, and  in  many  ways  increased  its  usefulness.  There 
is  the  necessary  subordinate  force  of  male  and  female 
employees. 

Regular  habits  of  living  and  employment  rather  than 
medicines  are  relied  upon  as  means  of  relief.  The  bromide 
of  potassium  used  is  obtained  from  Bielefeld,  but  it  is  given 
sparingly  ;  and  it  is  said  that  physically  the  patients  improve 
when  they  have  been  at  the  Homes  but  a  short  time.  The 
trustees  say  in  their  last  report  that,  during  the  year  1897, 
no  accident  or  disaster  occurred.  This  was  regarded  by 
them  as  remarkable,  as  the  record  showed  35 11  violent 
seizures  suffered  by  the  patients  during  that  time.  Not- 
withstanding there  was  an  average  of  more  than  nine  severe 
attacks    in    every    twenty-four    hours,   to    say    nothing    of 


l6o  CARE  AND    TREATMENT  OF  EPILEPTICS. 

innumerable  milder  ones,  the  Superintendent  and  sisters 
reported  a  year  of  steady  progress.  The  general  health  of 
the  inmates  and  helpers  was  good. 

During  the  year  the  farm  produced  twenty-five  tons  of 
hay,  besides  goodly  crops  of  wheat,  oats,  potatoes,  sweet 
and  field  corn,  tomatoes,  apples,  cherries,  and  other  fruits, 
as  also  all  the  milk  and  eggs  required,  while  the  gardens 
furnished  an  abundance  of  fresh  vegetables. 

The  principles  governing  the  institution  are  clearly  and 
tersely  expressed  in  the  words  of  President  Passavant.  He 
says:  "  The  quiet  influence  of  pious  example  on  the  part  of 
sisters,  and  the  religious  teaching  through  Sunday  service, 
weekly  Bible  class,  and  daily  worship,  morning  and  even- 
ing, are  relied  upon  to  do  much  to  calm  and  satisfy  the 
irritations  and  longings  of  the  patients,  whilst  simple,  well- 
cooked  food,  with  as  little  meat  as  is  consistent  with  the 
requirements  of  those  who  labor,  keeps  the  physical  man 
cheerful  and  strong.  All  work — as  much  out-of-doors  as 
possible — and  our  farm  of  sixty  acres  affords  every  facility 
for  diversified  occupations;  whilst  the  situation  of  the 
Homes  on  a  beautiful  hillside  overlooking  twenty  miles  of 
the  windings  of  the  Ohio  River,  with  its  encircling  hills,  is 
an  ideal  one  for  repose  and  beauty." 

THE    PENNSYLVANIA    TRAINING-SCHOOL    FOR    FEEBLE-MINDED 
CHILDREN. 

This  institution,  established  at  Elwyn,  Delaware  County, 
in  1859,  ls  a  private  corporation  liberally  aided  by  the  State. 
About  thirty-nine  per  cent,  of  the  children  are  supported 
wholly  by  the  State,  thirty  per  cent,  partially  by  the 
State,  fourteen  per  cent,  by  the  city  of  Philadelphia,  and  a 
majority  of  the  remainder  by  parents  or  guardians.  Con- 
nected with  the  institution  are  250  acres  of  land.     It  receives 


MARYLAND — SILVER    CROSS  HOME.  l6l 

inmates  from  other  States,  and  has  a  population  of  about 
one  thousand. 

Two  buildings  here  are  devoted  to  the  care  of  epileptics. 
The  one  for  boys  is  called  the  Manse  and  the  one  for 
girls  the  Chalet.  The  former  accommodates  143  and  the 
latter  60. 

Dr.  Martin  W.  Barr,  Superintendent,  says  regarding  the 
treatment  of  the  epileptics  under  his  care:  "  We  give  them 
plenty  of  exercise,  simple  diet,  consisting  of  weak  coffee, 
tea,  and  chocolate,  bread  and  milk,  broths,  soups,  Hamburg 
steak,  roast  potatoes,  roast  apples,  bananas,  etc. 

"  All  those  above  the  grade  of  idiots  attend  school,  but 
we  depend  mainly  upon  the  hand-work  rather  than  upon 
the  intellectual  training.  Our  treatment  is  confined  almost 
exclusively  to  the  bromides.  We  try  everything  new  that 
comes  out,  but  without  marked  success.  I  think  about 
seventy-five  per  cent,  are  somewhat  improved." 

MARYLAND. 

The  provision  in  Maryland  for  epileptics  and  the  feeble- 
minded is  entirely  inadequate.  Mr.  John  M.  Glenn,  in  writ- 
ing upon  the  subject,  says:  "It  is  difficult  to  get  either  of 
these  classes  into  the  State  institution.  There  is  always  a 
long  waiting  list.  We  find  encouragement  in  the  fact,  how- 
ever, that  the  public  conscience  is  awakening  gradually  to 
the  needs  of  epileptics,  and  we  hope  to  see  proper  provision 
made  for  them  in  a  few  years." 

THE    SILVER   CROSS   HOME    FOR   EPILEPTICS. 

This  Home  for  Epileptics  occupies  a  commanding  site 
overlooking  the  Susquehanna  River  at  Port  Deposit,  Mary- 
land.    It  originated  in  a  desire  of  the  King's  Daughters  of 


1 62  CARE  AND    TREATMENT  OF  EPILEPTICS. 

that  State  to  benefit  a  class  of  sufferers  needing  sympathy 
and  care.  The  gift  of  the  homestead,  with  three  acres  of 
land,  by  Mrs.  Woodward  Abrahams  and  her  children,  and 
the  immediate  furnishing  of  the  same,  chiefly  by  various 
circles  of  the  King's  Daughters  in  the  State,  made  it  prac- 
ticable to  open  the  Home  on  the  30th  of  June,  1891.  Its 
capacity  is  limited  to  twenty  patients.  Applications  for 
admission  by  deserving  cases  are  numerous  and  pressing. 
A  moderate  sum  is  usually  charged  for  treatment,  but 
some  inmates  are  supported  free.  Aside  from  the  income 
received  from  patients,  the  expenses  of  the  institution  are 
met  by  voluntary  contributions.  Although  only  women 
and  girls  are  admitted,  the  acreage  of  land  is  much  too  small 
to  meet  the  requirements  of  the  home. 

The  treatment  is  chiefly  hygienic  and  dietary,  but  medical 
treatment  is  administered  and  surgical  operations  are  per- 
formed whenever  they  are  considered  necessary  to  the  wel- 
fare of  the  patient.  The  general  health  of  the  inmates  is 
good.  The  President  of  the  Home,  Mrs.  John  Thomas 
Mason,  says  of  it:  "  The  treatment  is  simple  in  the  ex- 
treme. Every  patient  has  improved  in  a  remarkable  man- 
ner after  a  few  weeks'  sojourn  at  the  Home.  We  give  the 
inmates  plenty  of  milk,  butter,  eggs,  oatmeal,  cocoa,  good 
bread,  fruit,  stewed  and  fresh,  but  few  sweets,  and  nothing 
fried.  They  have  very  little  meat,  and  that  boiled  and 
generally  chopped.  We  regard  steady  employment  as  a 
great  factor  for  good.  The  patients  do  most  of  the  work 
of  the  house  of  their  own  accord  and  also  work  in  the  gar- 
den. They  are  tractable  and  obedient,  and  are  generally 
happy  and  contented.  At  times  some  of  them  show  symp- 
toms of  mania,  especially  the  new  patients.  No  restraint 
is  used,  and  bromide  is  administered  only  on  rare  occasions. 
A  gentle  but  firm  control  is  exercised  over  them  by  an 


MISSOURI.  163 

experienced  nurse.  The  institution  is  free  from  debt  and 
prospering,  although  much  more  could  be  spent  to  its 
advantage  in  the  way  of  extension  and  improvement." 

MARYLAND   ASYLUM   AND    TRAINING-SCHOOL   FOR   FEEBLE-MINDED. 

This  institution  is  located  at  Owing's  Mills,  Baltimore 
County,  and  receives  epileptic  children  along  with  feeble- 
minded patients.  It  is  managed  by  a  Board  of  Trustees 
appointed  by  the  Governor,  and  is  supported  by  State  ap- 
propriations, supplemented  by  private  contributions.  The 
State  having  failed  to  provide  separate  accommodations  for 
epileptics,  although  repeatedly  urged  to  do  so,  a  member  of 
the  Board  of  Trustees,  Mr.  J.  Pembroke  Thorn,  generously 
contributed  $5500  towards  this  object.  Thus  a  separate  cot- 
tage for  epileptics,  with  accommodations  for  twenty-nine 
patients,  was  added  to  the  buildings  erected  for  the  feeble- 
minded. It  is  a  substantial  two-story  stone  structure,  with 
basement,  and  is  provided  with  a  schoolroom,  playroom, 
and  teachers'  quarters.  It  is  comfortably  furnished  and 
heated  with  hot  water. 

The  trustees  declare  that  their  experience  has  demon- 
strated the  wisdom  of  making  separate  provision  for  the 
two  classes  under  their  care. 

Connected  with  the  institution  are  186  acres  of  land,  100 
of  which  are  under  cultivation.  The  farm  and  garden  are 
no  inconsiderable  factors  in  the  industrial  life. 

MISSOURI. 

An  act  establishing  a  State  Board  of  Charities  and  Cor- 
rections was  passed  by  the  Legislature  of  Missouri,  March 
19,  1897.  Under  the  auspices  of  the  Board  a  bill  was  intro- 
duced in  the  Legislature  of  1899  for  establishing  a  colony 


164  CARE  AND    TREATMENT  OF  EPILEPTICS. 

for  feeble-minded  and  epileptics.  The  aim  of  the  promoters 
of  the  project,  in  which  the  Vice-President  of  the  State 
Board  of  Charities  and  Corrections,  Miss  Mary  E.  Perry,  is 
specially  interested,  is  to  provide  for  the  time  being,  on  the 
same  estate,  separate  departments  for  epileptics  and  feeble- 
minded. 

The  object  of  the  colony,  as  set  forth  in  Section  2  of  the 
act,  is  "to  secure  the  humane,  curative,  scientific,  and 
economical  treatment  and  care  of  the  feeble-minded  and 
epileptics."  To  accomplish  this  purpose  it  is  provided  that 
a  tract  of  fertile  and  productive  land  shall  be  obtained  in  a 
healthful  situation,  with  an  abundant  supply  of  wholesome 
water  and  sufficient  means  of  drainage  and  for  the  disposal 
of  sewage ;  and  that  there  shall  be  furnished,  among  other 
necessary  structures,  cottages  for  dormitory  and  domiciliary 
uses,  buildings  for  an  infirmary,  a  schoolhouse,  and  a  chapel, 
workshops  for  the  proper  teaching  and  productive  prosecu- 
tion of  trades  and  industries,  all  of  which  structures  shall 
be  substantial  and  attractive,  but  plain  and  moderate  in 
cost,  and  arranged  on  the  colony  plan.  It  is  provided 
that  the  tract  of  land  shall  be  of  sufficient  extent  to  erect 
thereon  the  necessary  houses  and  furnish  employment  for 
the  patients.  The  sum  of  $30,000  was  appropriated  towards 
carrying  out  the  purposes  of  the  act. 

The  Board  of  Managers  is  required  to  appoint  outside  of 
its  members  a  Superintendent  and  a  Treasurer.  The  former 
must  be  a  well-educated  physician  and  a  graduate  of  a 
legally  chartered  medical  college,  with  at  least  five  years' 
actual  practice  in  his  profession,  including  at  least  one 
year's  actual  experience  in  a  general  hospital.  These 
officers  may  be  discharged  or  suspended  at  the  discretion 
of  the  Board.  The  Superintendent  is  the  chief  executive 
officer  of  the  colony,  subject  to  the  supervision  and  control 


EMMA  US.  165 

of  the  Board  of  Managers.  It  is  provided  that  the  Board 
of  Managers  shall  consist  of  five  members,  two  of  whom 
shall  be  women. 

In  accordance  with  Section  12  of  the  act,  the  following 
classes  of  patients  may  be  admitted  into  the  colony  :  "  There 
shall  be  received  and  gratuitously  supported  in  the  colony 
feeble-minded  and  epileptics  residing  in  the  State,  who,  if 
of  age,  are  unable,  or,  if  under  age,  whose  parents  or 
guardians  are  unable  to  provide  for  their  support  therein, 
and  who  shall  be  designated  as  State  patients.  Such  addi- 
tional number  of  feeble-minded  and  epileptics,  whether  of 
age  or  under  age,  as  can  be  conveniently  accommodated, 
shall  be  received  into  the  colony  by  the  managers  on  such 
terms  as  shall  be  just,  and  shall  be  designated  as  private 
patients." 

Power  is  vested  in  the  Superintendent,  with  the  approval 
of  the  Board  of  Managers,  to  discharge  any  patient  who  in 
their  judgment  has  fully  recovered.  If  any  patient  becomes 
dangerously  insane  he  must  be  placed  in  the  asylum  located 
nearest  to  the  county  from  which  he  was  sent  to  the  colony. 

EMMAUS. 

Emmaus,  about  four  miles  from  the  town  of  Marthasville, 
in  Missouri,  is  the  only  institution  west  of  the  Mississippi 
devoted  exclusively  to  the  treatment  of  epileptics. 

By  a  resolution  of  the  German  Evangelical  Synod  of  North 
America,  passed  in  1892,  the  former  college  buildings  of  the 
Synod  were  set  apart  to  be  used  as  a  home  for  epileptics  under 
the  government  of  a  legally  organized  Board  of  Directors. 
This  home  was  formally  dedicated  July  2,  1893,  and  a  few 
days  later  it  received  its  first  patient.  There,  among  the 
wooded  hills  of  Missouri,  is  carried  on  in  a  small  way  a 
work  of  love  similar  to  that  at  Bielefeld.     The  charity  was 


1 66  CARE  AND    TREATMENT  OF  EPILEPTICS. 

organized  by  Rev.  C.  Schnake.  Two  buildings  of  stone, 
spacious,  well  lighted,  and  well  ventilated,  afford  accommo- 
dations for  fifty  patients,  and,  together  with  the  residence 
of  the  Superintendent  and  a  small  chapel,  comprise  the 
buildings  of  the  colony.  The  estate  contains  240  acres, 
the  greater  part  of  which  has  not  been  cleared  and  fitted  for 
field  use. 

The  Rev.  C.  F.  Sturm,  Superintendent,  or,  as  the 
German  tongue  beautifully  expresses  it,  the  house-father, 
in  reply  to  a  recent  letter  of  inquiry,  said  that  twenty-three 
men,  sixteen  women,  one  boy,  and  two  girls,  who  were 
ministered  unto  by  six  nurses — three  male  and  three  female 
— constituted  the  beneficiaries  of  the  institution.  Such  of 
the  male  patients  as  are  able  to  work  are  employed  in  the 
fields  or  in  the  garden  in  summer  and  in  the  care  of 
stock  and  clearing  up  the  land  in  winter.  Seventeen  were 
wholly  dependent  upon  the  home  and  had  been  admitted 
into  the  institution  solely  through  Christian  charity.  The 
usual  charge  for  support,  if  patients  are  able  to  pay,  is  $200 
a  year  for  adults  and  $150  a  year  for  minors.  The  same 
care  and  treatment  are  given  those  who  pay,  according 
to  their  ability,  a  reduced  sum  or  nothing,  as  are  enjoyed 
by  those  who  are  able  to  pay  the  regular  fees.  Nationality 
and  religious  belief  are  not  considered  in  the  admission  of 
patients.  Each  day  is  begun  with  family  worship — reading 
the  Scriptures,  prayer,  and  song.  Though  not  compelled  or 
unduly  urged,  the  inmates  find  welcome  at  the  Sabbath-day 
service  in  the  chapel  each  week. 

The  treatment  of  epileptic  patients  at  Emmaus  is  three- 
fold in  its  nature — hygienic,  psychical,  and  medical.  Great 
care  is  taken  that  the  diet  shall  be  nourishing  to  the  body, 
and  the  physical  health  is  further  strengthened  by  warm 
and  cold  baths  and  outdoor  exercise.      Every  effort  is  put 


EMMA  US.  167 

forth  to  strengthen  the  will-power  of  the  epileptic,  which 
becomes  weakened  by  repeated  paroxysms.  The  medical 
treatment  and  diet  are  the  same  as  at  the  Bethel  Colony, 
near  Bielefeld. 

The  female  department  of  the  asylum  having  become 
crowded,  the  directors  recently  purchased  no  acres  of 
choice  cultivated  land  in  a  healthful,  elevated  situation 
near  St.  Charles,  on  the  banks  of  the  Missouri  River,  where 
it  is  proposed  to  erect  buildings  for  the  care  of  the  female 
epileptics.  A  department  for  this  class  has  already  been 
established  there  in  commodious  buildings  temporarily 
rented.  This  branch  of  the  asylum  is  under  the  care  of 
Rev.  J.  D.  Illg,  Superintendent.  St.  Charles  is  readily 
accessible  by  two  railways  from  St.  Louis,  of  which  it  is  a 
suburb. 

The  general  control  of  the  institution  is  vested  in  a  Board 
of  nine  Directors,  and  the  immediate  management  is  in 
charge  of  the  superintendents  and  physicians.  The  medical 
department  is  under  the  direction  of  Dr.  E.  A.  Rembe. 
For  support,  the  home  depends  upon  individual  gifts  and 
the  fees  received  from  patients. 

The  results  of  the  treatment  at  Emmaus  have  been  en- 
couraging, considering  the  few  years  of  the  existence  of 
the  institution.  Many  have  been  greatly  improved  and 
some  have  been  declared  cured.  Very  great  relief  has  been 
afforded  in  nearly  every  case. 


CHAPTER   VI. 

CALIFORNIA,  MICHIGAN,  MINNESOTA,  WISCONSIN, 
WEST  VIRGINIA. 


CALIFORNIA. 

THE  care  of  epileptics  in  California  is  united  with  that 
of  the  feeble-minded,  idiots,  and  mentally  enfeebled 
paralytics,  under  the  incorporation  known  as  the  "  California 
Home  for  the  Care  and  Training  of  Feeble-Minded  Chil- 
dren." Articles  of  incorporation  for  this  institution  were 
perfected  in  1883,  and  work  was  begun  at  White  Sulphur 
Springs,  near  Vallejo,  in  May,  1884.  It  was  found  imprac- 
ticable, however,  to  conduct  the  work  on  a  scale  com- 
mensurate with  its  needs  without  placing  it  under  State 
auspices.  By  an  act  passed  March  18,  1885,  the  State 
assumed  control  of  the  institution,  appropriated  $25,000  for 
the  purchase  of  a  suitable  property,  and  authorized  the  dis- 
bursement of  $20,000  for  two  years'  support  of  the  Home. 
A  site  of  fifty-one  acres  was  secured  at  Santa  Clara,  upon 
which  were  some  buildings,  and  others  were  erected  thereon. 
It  was  soon  evident  that  a  mistake  had  been  made  in 
purchasing  so  small  a  tract  of  land,  and  that  a  change  of 
site  was  absolutely  necessary ;  and  a  commission  was  ap- 
pointed to  select  a  new  one.  Acting  upon  the  liberal 
principles  which  should  govern  State  enterprises,  the  com- 
mission recommended  the  purchase  of  1700  acres  of  fertile 
land — foothill  and  valley — at   Eldridge,   near  Glen   Ellen, 

168 


CALIFORNIA.  1 69 

Sonoma  County.  This  was  considered  an  ideal  site.  A 
large  part  of  the  tract,  including  eighty  acres  of  orchard  and 
vineyard,  had  been  under  cultivation  for  twenty-five  years. 
The  water-supply  was  inexhaustible,  the  drainage  good,  the 
climate  salubrious,  and  railway  facilities  satisfactory.  The 
property  was  at  length  purchased  and  buildings  erected  there- 
on by  the  State ;  and  the  beneficiaries  of  the  corporation, 
numbering  about  150,  were  removed  from  Santa  Clara  to 
their  new  home  November  24,  1891.  The  securing  of  this 
large  estate  opened  the  way  to  broaden  the  work  of  the  in- 
stitution so  as  to  include  a  much  greater  number  of  the 
unfortunate  persons  of  the  State  than  was  at  first  contem- 
plated. In  this  aim,  Dr.  A.  E.  Osborne,  the  Superin- 
tendent, has  labored  with  unremitting  zeal,  and  by  his 
facile  pen  and  personal  influence  has  instructed  the  public 
in  its  duty  to  the  afflicted  classes  of  the  State.  Under  the 
auspices  of  the  institution  Dr.  Osborne  has  edited  for  many 
years  a  quarterly  periodical  entitled  The  Institution  Bulletin, 
through  which  he  has  disseminated  a  vast  amount  of  in- 
formation  for  the  benefit  of  workers  in  various  spheres  of 
charity. 

The  beginning  of  State  provision  for  epileptics  in  Cali- 
fornia is  thus  described  by  Dr.  Osborne: 

"  There  was  practically  no  organized  system  of  caring  for 
epileptics  in  California  until  the  year  1886,  when  I  took  up 
in  a  small  way  the  care  of  a  few  selected  cases  in  connection 
with  the  regular  work  of  the  care  and  training  of  the  feeble- 
minded in  this  institution.  These  selected  cases  were  such 
as  were  complicated  with  imbecility  or  idiocy,  and  might 
not,  therefore,  invite  criticism  on  the  part  of  a  captious 
public.  At  the  session  of  the  Legislature  of  1887,  an  act 
was  passed,  in  accordance  with  my  earnest  recommendation, 
which  re-established  the  legal  and  civic  foundation  of  the 


I  JO  CARE  AND    TREATMENT  OF  EPILEPTICS. 

institution.  This  act  extended  the  powers  of  the  manage- 
ment and  widened  the  scope  of  the  work.     .     .     . 

"  Up  to  this  time  the  epileptics  of  the  State,  if  cared  for 
at  all  in  institutions,  were  sent  to  the  insane  asylums — a 
condition  of  affairs  which  was  as  unjust  to  the  management 
of  these  asylums  as  it  was  unfair  to  the  rights  of  the 
epileptic. 

"  Progress  along  the  lines  I  had  contemplated  was  neces- 
sarily slow,  owing  to  a  combination  of  circumstances,  chief 
among  which  was  the  inadequate  plant  and  acreage  then 
possessed  by  the  Home.  Several  years  were  consumed  in 
a  memorable  and  fiercely  contested  struggle  to  secure  a  new 
site.  As  a  result  of  this  contest  the  present  unique  loca- 
tion, with  its  superb  advantages  and  broad  domain  of 
1700  acres,  was  secured.  Necessary  delays  in  the  erection 
of  buildings  still  further  put  off  the  day  for  the  rational  care 
of  the  epileptics  who  were  pleading  at  our  gates.  However, 
I  secured  the  erection  of  a  small  building,  which  is  termed 
the  Manse,  for  the  care  of  epileptic  cases." 

The  corner-stone  of  this  one-story  structure,  with  accom- 
modations for  sixty  cases,  was  laid  with  appropriate  cere- 
monies in  November,  1890.  The  building  has  been  filled 
from  the  day  of  its  completion,  and  there  is  now  a  pressure 
for  further  accommodation,  also  need  of  classification  of 
epileptics  of  various  grades.  Until  recently,  only  such  epi- 
leptic cases  as  have  shown  marked  mental  enfeeblement 
have  been  admitted.  It  is  intended  to  supplement  the 
Manse  with  similar  cottage  structures,  in  order  to  extend 
the  benefits  of  the  institution  to  a  more  curable  and  hopeful 
class  of  patients.  Insane  epileptics  are  not  received.  If  a 
patient  becomes  insane  after  admission  he  is  promptly  sent 
to  one  of  the  State  hospitals  for  the  insane. 

Referring  to  the  erection  of  the  Manse,  Dr.  Osborne  says : 


CALIFORNIA.  171 

"  You  will  no  doubt  recognize  in  this  the  foreshadowing 
of  my  general  design  and  my  opinions  as  to  what  should 
constitute  an  ideal  institution  for  the  care  of  the  masses  of 
epileptics.  While  working  along  these  lines  I  know  I  have 
gone  in  almost  direct  opposition  to  the  opinions  expressed 
by  my  Eastern  colleagues,  who  have  long  advocated  the 
separation  of  all  epileptic  cases  from  the  work  of  caring  for 
and  educating  the  feeble-minded.  My  aim  has  been  to 
build  up  here,  in  California,  a  great  State  work,  which  shall 
include  under  its  ample  care  every  worthy  epileptic  and 
feeble-minded  person.  According  to  our  environment,  I 
can  see  no  reason  why  this  cannot  be  done  with  exact 
justice  to  each  class  to  be  cared  for,  and  in  perfect  harmony 
of  relationship.  Our  ample  acreage,  our  abundant  water- 
supply,  our  diversified  grounds,  our  railroad  facilities,  with 
the  other  advantages  which  we  enjoy,  constitute  dominant 
factors  in  the  determination  of  such  a  choice.  We  can 
easily  accommodate  a  thousand  epileptics  on  the  cottage  or 
colony  plan,  and  a  thousand  or  more  feeble-minded,  with- 
out one  class  crowding  or  interfering  with  the  other,  and 
still  have  plenty  of  breathing-room  left." 

In  March,  1897,  the  Legislature  passed  an  act  embodying 
a  plan  promoted  by  Dr.  Osborne,  which  defines  the  present 
relation  of  the  State  to  epileptics  as  well  as  to  certain  other 
classes  already  named.  The  leading  provisions  of  the  act 
are  essentially  as  follows: 

'  The  management  of  the  California  Home  for  the  Care 
and  Training  of  Feeble-Minded  Children  is  hereby  author- 
ized, empowered,  and  directed  to  admit  therein  and  thereto, 
in  addition  to  imbeciles  and  feeble-minded  persons,  such 
idiots,  epileptics,  and  mentally  enfeebled  paralytics,  irre- 
spective of  age,  as  the  accommodations  of  the  Home  may 
permit,  and  as  may,  in  the  judgment  of  the  management, 


172  CARE  AND    TREATMENT  OF  EPILEPTICS. 

appear  suitable  subjects  for  such  admission,  and  upon  such 
formal  commitment  as  is  now  prescribed  by  law  for  the 
feeble  -  minded.  But  for  each  idiotic,  imbecile,  feeble- 
minded, paralytic,  or  epileptic  person  thus  committed  to 
the  Home,  the  Judge  of  the  Superior  Court  who  officiates 
shall  make  such  order  or  orders  as  are  requisite  and  proper 
to  secure  the  payment  by  the  county  from  which  the  appli- 
cant is  committed,  to  the  State  Treasurer,  of  the  sum  of  ten 
dollars  monthly,  for  and  during  each  and  every  month  or 
part  of  a  month  the  said  applicant  so  committed  remains 
an  inmate  of  said  institution. 

"  No  person  shall  be  deemed  eligible  for  commitment  to, 
or  admission  into,  said  institution  unless  he  has  been  a  resi- 
dent of  the  State  for  the  period  of  one  year  immediately 
preceding  the  date  of  application.  The  Board  may  cause 
the  peremptory  discharge  from  said  institution  of  any  per- 
son who  has  been  an  inmate  or  patient  of  said  institution 
for  the  period  of  one  month. 

"  The  Board  of  Trustees  of  the  Home,  when  the  accom- 
modations of  the  Home  permit,  and  provided,  further,  that 
such  action  does  not  conflict  with  the  interests  or  welfare 
of  committed  cases  or  applicants  awaiting  admission,  may 
admit,  for  any  stated  period  of  time,  without  judicial  com- 
mitment, such  persons  as  are  before  and  hereinafter  speci- 
fied as  eligible  for  admission,  upon  such  terms  of  special 
payment,  gift,  bequest,  donation,  legacy,  transfer  of  real  or 
personal  property,  or  other  lawful  procedure,  as  may  appear 
to  them  to  be  for  the  best  interests  of  the  State,  and  may, 
further,  secure  to  the  Home,  for  the  time  such  persons  so 
admitted  are  inmates  of  the  Home,  such  revenue  or  com- 
pensation as  fully  covers  the  actual  cost  to  the  Home  for  all 
care,  treatment,  education,  and  support  therein  involved." 

Respecting  the  efficacy  of  the  foregoing  act,  Dr.  Osborne 


CALIFORNIA.  1 73 

says:  "  Its  operations  have  exceeded  our  sanguine  hopes, 
and  placed  the  institution  upon  a  basis  of  which  we  feel 
justly  proud.  The  law  virtually  establishes  State  care  for 
epileptics  in  this  place,  and  while  it  carries  no  provision 
for  buildings  with  it,  it  opens  our  doors  without  reserve  or 
possible  criticism  to  any  epileptic  or  paralytic  who  might 
seek  shelter  and  treatment  here.  It  is  not  generally  so 
understood,  but,  nevertheless,  it  is  a  fact  that  may 
paralytics  suffer  from  mental  defect  or  deficiencies  and  re- 
quire institutional  care,  seclusion,  and  treatment  quite  as 
much  as  any  other  class  of  patients. 

"  Under  the  provisions  of  this  act  several  so-called  sane 
epileptics  have  voluntarily  submitted  themselves  for  treat- 
ment, and  others  are  anxious  to,  but  are  debarred  at  present 
by  lack  of  accommodations.  Our  plans  for  the  future  have 
not  been  fully  completed,  since  we  shall  have  to  await  the 
action  of  the  Legislature  to  secure  appropriations  for  the 
necessary  buildings  to  care  for  the  large  number  of  epilep- 
tics and  paralytics  who  are  waiting  to  be  admitted." 

Although  my  views  are  not  in  accord  with  Dr.  Osborne's 
respecting  the  care  and  treatment  of  widely  different  classes 
of  dependent  persons  in  the  same  institution,  his  experience 
in  the  treatment  of  epileptics  entitles  his  opinions  to  just 
consideration.  In  a  letter  dated  March  5,  1898,  replying 
to  my  inquiries,  he  very  kindly  gave  the  following  infor- 
mation : 

"  We  have  now  in  the  institution  200  epileptic  and  epi- 
leptoid  cases  out  of  a  total  population  of  525.  The  number 
in  the  insane  hospitals  of  the  State  I  do  not  know,  but 
presume  it  must  reach  near  a  thousand  for  all  classes,  prob- 
ably less  than  half  of  whom  are  eligible  for  transfer  to  our 
colony  here. 

"  Respecting  the  daily  order  of   life,   I    must    say  that 


174  CARE  AND    TREATMENT  OF  EPILEPTICS. 

regularity  is  the  prime  essential.  We  apply  this  to  play  as 
well  as  to  work,  and  the  same  can  be  said  of  refreshment. 
Music,  because  of  its  pleasing  harmonies,  especially  the 
more  soothing  melodies,  and  its  high  expression  of  time,  is 
always  grateful  to  these  patients,  tending  to  establish  a 
psychical  rhythm,  as  a  sort  of  mental  gymnastics  to  their 
disordered  psychical  organizations.  The  leading  character- 
istic of  epilepsy  is  its  element  of  irregularity,  and  anything 
which  tends  to  antidote  this  prominent  feature  of  the  dis- 
order is  directly  palliative,  if  not  curative,  in  its  effects. 

"  I  consider  the  very  best  industrial  occupation  that  line 
of  work  which  will  bring  the  patient  in  contact  with  the  dry 
warm  earth.  The  long  dry,  cloudless,  and  warm  seasons  in 
this  State  permit  of  epileptics  working  out-of-doors  upon 
the  farm,  in  the  gardens,  and  on  the  grounds.  There  are 
very  few  days  in  the  year  in  this  locality  that  we  cannot 
have  our  epileptics  out-of  doors,  exercising,  if  nothing  more. 
We  employ  epileptics,  however,  in  other  capacities,  such 
as  tailoring,  sewing,  and  dressmaking,  shoemaking,  house- 
work, etc.  I  think  it  is  of  advantage  to  place  epileptics 
where  they  will  be  required  to  use  more  than  ordinary 
mental  effort  to  maintain  their  status.  The  mental  drill  in- 
volved is  particularly  beneficial.  Consequently,  we  often 
assume  what  other  people  might  consider  risks.  It  is  of 
course  understood  that  we  do  not  relax  our  vigilance  over 
them,  although  we  try  to  have  them  feel  that  in  the  Home 
they  can  do  more  for  themselves,  and  do  it  to  better  advan- 
tage and  with  less  supervision,  than  they  ever  did  for  them- 
selves before. 

"  We  have  no  fixed  dietary.  Over  twenty  years'  ex- 
perience with  this  class  of  people  has  shown  me  the  fallacy 
of  considering  them  all  alike.  To  some  we  give  meat,  to 
others  we  do  not;  some  have  largely  a  nitrogenous  diet, 


BOYS'   KINDERGARTEN    CLASS    (California   Home' 


GIRLS'   KINDERGARTEN    CLASS    (California  Home1. 


CALIFORNIA.  1 75 

others  have  little  nitrogen  in  their  food.  We  are  guided 
in  this  matter  by  the  physical  and  mental  condition  of 
the  patient  himself,  and  the  character  of  his  spasms  and 
their  frequency.  As  to  what  we  give  the  patients,  we  aim 
to  have  it  of  superior  quality,  well  cooked,  easily  digest- 
ible, and  given  in  such  quantities  and  at  such  intervals 
as  may  not  overload  the  stomach,  and  thus  overtax  the 
visceral  organs. 

"  As  to  my  ideal  of  an  institution  for  the  care  and  treat- 
ment of  epileptic  children,  I  give  my  answer  without  hesita- 
tion— a  cottage  settlement  in  connection  with  a  progressive 
and  well-equipped  institution  for  the  care,  training,  and  edu- 
cation of  feeble-minded  children.  While  epileptic  children 
need  some  medical  attention,  their  infirmities  are  such 
as  require  more  the  skilled  care  and  training  of  patient 
and  competent  teachers,  who  have  schooled  themselves 
in  the  intricacies  of  mental  defects  and  perversions  shown 
by  the  purely  feeble-minded.  With  epileptic  children  it  is 
largely  a  question  of  how  well  their  handicapped  mentali- 
ties may  be  developed,  and  for  all  their  psychical  aberrations 
I  know  of  nothing  so  promising  in  the  matter  of  treatment 
as  properly  selected  and  carefully  applied  educational  forms 
and  drills.  The  physician  and  the  teacher  are  indispensably 
needed  as  much  as  the  physician  and  the  trained  nurse  are 
needed  with  the  physically  sick.  One  cannot  cure  without 
the  aid  of  the  other,  though  the  burden  of  the  work  must 
fall  upon  the  shoulders  of  the  teacher,  to  whom  I  would 
accord  the  just  meed  of  praise  and  credit.  If  the  epileptic 
child  under  the  system  suggested  is  benefited  to  the  extent 
that  it  can  go  out  into  the  world,  well  and  good ;  if,  on  the 
other  hand,  it  retrogrades,  it  finds  its  level  in  the  sequestered 
wards  of  that  department  of  the  institution  which  may  care 
for  the  hopeless  imbecile." 


176  CARE  AND    TREATMENT  OF  EPILEPTICS. 

The  Home  has  expended  upwards  of  half  a  million  dollars 
for  land  and  buildings.  With  the  plant  as  now  established, 
Dr.  Osborne  thinks  that  the  per  capita  cost  of  support,  ex- 
clusive of  salaries,  need  not  exceed  $100  per  annum. 

In  regard  to  the  prospective  development  of  the  Home, 
Dr.  Osborne  writes,  under  date  of  March  31,  1899,  that,  al- 
though the  last  Legislature  granted  very  liberal  aid  in  all  the 
lines  desired  by  the  managers  of  the  institution  he  repre- 
sents, its  action  did  not  meet  the  approval  of  the  Governor. 
"  My  plans  for  the  epileptic,"  he  says,  "  are  therefore  of 
necessity  to  amount  to  little,  so  far  as  State  care  is  con- 
cerned, for  at  least  two  years  more.  The  '  campaign  of 
education,'  however,  will  go  on  so  long  as  I  have  a  voice 
to  raise  in  behalf  of  these  miserable  people  and  until  some- 
thing is  done  to  better  their  condition." 

MICHIGAN. 

As  a  result  of  fifteen  years  of  persistent  agitation  and  dis- 
cussion, the  Legislature  of  Michigan,  in  1893,  established, 
on  the  cottage  plan,  the  Michigan  Home  for  the  Feeble- 
Minded  and  Epileptic,  at  Lapeer.  The  institution  was  not 
formally  opened  until  1895.  During  the  summer  of  1897 
a  building  designed  to  accommodate  76  female  epileptics 
was  erected,  costing,  with  furniture,  $18,000. 

Connected  with  the  Home  are  160  acres  of  land,  and  the 
management  has  secured  an  option  on  600  adjoining  acres. 

The  institution  is  custodial  in  its  policy.  "  All  feeble- 
minded and  epileptic  persons  above  the  age  of  six  years, 
who  are  legal  residents  of  the  State  of  Michigan,  may,  in 
the  discretion  of  the  Board,  be  admitted  to  the  Home 
without  charge  for  tuition,  board,  washing,  medicine,  or 
medical  attendance.  But  where  the  parents  or  guardians 
of  any  person  or  persons  who  may  be  admitted  are  able  to 


MINNESOTA.  1 77 

contribute  to  their  support  in  whole  or  in  part,  they  may 
be  required  to  do  so  under  uniform  rules  to  be  established 
by  the  Board  of  Control.  In  the  selection  of  inmates  pref- 
erence shall  be  given  to  indigent  or  pauper  orphan  children ; 
and  when  this  class  is  provided  for,  such  others  may  be  ad- 
mitted for  whom  application  may  be  made  whenever  suitable 
accommodations  have  been  provided ;  and  when  these  classes 
are  provided  for,  other  feeble-minded  and  epileptic  persons 
may  be  received." 

Between  two  hundred  and  three  hundred  feeble-minded 
and  epileptic  children  were  waiting  for  admission  at  the 
close  of  1897.  Other  buildings  for  epileptics  have  been 
projected. 

MINNESOTA. 

In  its  Biennial  Report  for  the  period  ending  July  1,  1896, 
the  State  Board  of  Corrections  and  Charities  referred  to  the 
opening  of  a  special  department  for  epileptic  children  in  the 
Minnesota  School  for  Feeble-Minded  as  likely  to  meet  a 
public  want,  although  it  would  greatly  increase  the  pres- 
sure for  admission  to  that  institution.  The  Board  esti- 
mated that  there  were  not  less  than  one  thousand  epileptics 
in  the  State,  a  large  proportion  of  whom  would  desire  ad- 
mission to  the  School  and  many  of  them  would  contribute  to 
their  own  support  by  labor.  The  Board  in  conclusion  said  : 
"  If  the  State  is  to  undertake  this  great  work,  however,  we 
think  that  it  would  be  the  best  policy  to  establish  a  new 
and  distinct  institution." 

The  Minnesota  School  for  Feeble-Minded  is  supported 
entirely  by  the  State.  At  the  date  of  January  5,  1898, 
there  were  in  the  institution  151  epileptics  varying  from 
early  childhood  to  old  age.  Ninety-three  were  males  and 
58  were  females.     Of  the  whole  number,  42  males  and  26 


178  CARE  AND    TREATMENT  OF  EPILEPTICS. 

females  are  provided  for  separately  from  other  patients. 
A  section  of  one  of  the  buildings  is  devoted  exclusively 
to  the  boys.  They  have  their  meals,  lodging,  training, 
and  industrial  occupation  distinct  from  the  feeble-minded. 
The  family  of  epileptic  girls  dine  with  the  other  inmates. 
A  comfortable  cottage  is  about  completed,  however,  where 
they  will  be  entirely  separated  from  the  others.  The  re- 
maining epileptics  are  quite  idiotic,  and  they  are  distributed 
throughout  the  custodial  department.  In  the  care  of  the 
latter  no  distinction  is  made  from  that  of  their  associ- 
ates. Dr.  A.  C.  Rogers,  Superintendent,  says  that  "  medi- 
cal and  industrial  treatment  are  carefully  studied.  We 
think  occupation,  especially  out-of-doors,  is  of  equal  im- 
portance with  medical  treatment,  and  in  many  cases  is  of 
more  importance  than  the  latter.  School  training  is  open 
to  epileptics  to  a  limited  degree,  but  I  do  not  consider  it  of 
very  much  importance  unless  the  cases  improve  in  general 
health."  Dr.  Rogers  makes  the  emphatic  declaration  that 
he  believes  separate  industrial  and  home  colonies  for  epi- 
leptics the  best  system  yet  devised  for  them. 

WISCONSIN. 

No  provision  is  made  in  Wisconsin  for  the  special  care*  of 
epileptics  in  entirely  separate  institutions.  The  Wisconsin 
Legislature,  in  1895,  instructed  the  State  Board  of  Control 
to  acquire  sufficient  land  for  a  home  for  the  feeble-minded 
and  epileptics  of  the  State,  and  appropriated  $100,000  for 
this  purpose  and  the  erection  of  buildings.  A  site  embra- 
cing about  six  hundred  acres  was  accepted  as  a  gift  from 
Chippewa  Falls,  from  which  city  it  is  about  half  a  mile 
distant.  In  addition  to  the  land,  a  bonus  of  $10,000  was 
given  to  secure  the  location  of  the  home  at  that  place. 
In  order  to  obtain  the  amount  of  land  desired  the  State 


WEST    VIRGINIA.  1 79 

was  obliged  to  purchase  421  acres  more,  making  a  total  of 
102 1  acres. 

The  institution,  when  completed,  will  include  two  build- 
ings for  epileptics,  differing  from  the  general  plan  of  the 
others  by  having  separate  dining-rooms.  Each  of  these 
departments  will  accommodate  seventy-five  inmates.  Only 
the  better  class  of  patients  will  be  admitted  to  these  dwell- 
ings, the  low-grade  epileptic  children  being  cared  for  in  a 
general  custodial  building  near  at  hand.  Of  the  fifteen 
structures  originally  designed  for  the  complete  plan  of  this 
institution,  but  two  large  buildings  ultimately  intended  for 
custodial  care,  and  one  of  the  buildings  for  epileptics,  are 
erected.  The  age  limit  for  admission  is  thirty  years  for 
males  and  forty  years  for  females. 

Superintendent  Wilmarth  writes:  "  Our  plant  will  include 
two  schoolhouses  and  a  gymnasium  building.  We  shall 
also  open  shops  of  various  kinds  and  develop  industrial 
training  to  its  greatest  possible  limit.  Epileptics  will  share 
the  school  and  industrial  work  so  far  as  their  condition  will 
allow.  Their  treatment  will  consist  of  such  medical  and 
dietary  measures  as  their  individual  cases  may  seem  to  re- 
quire. I  am  a  firm  believer  in  the  efficacy  of  systematic 
occupation  for  epileptics  as  a  remedial  agent,  and  intend 
that  they  shall  all  have  such  regular  daily  work  as  they 
are  capable  of  performing." 

WEST   VIRGINIA. 

Four  years  ago  a  bill  was  introduced  in  the  Legislature 
of  West  Virginia  through  the  efforts  of  Mrs.  Mary  Jackson 
Ruffner,  of  Charleston,  providing  for  an  Asylum  for  In- 
curables. Not  disheartened  by  the  defeat  of  the  measure, 
Mrs.  Ruffner  secured  the  introduction  of  the  bill  at  a  sub- 
sequent session  of  the  Legislature,  strengthening  her  plea 


l80  CARE  AND    TREATMENT  OF  EPILEPTICS. 

for  its  passage  by  placing  upon  the  table  before  the  legisla- 
tive committee  whom  she  was  addressing  a  poor,  suffering, 
incurable  child,  whose  pitiable  condition  so  appealed  to 
each  heart  that  the  vote  of  every  member  was  cast  for  the 
bill,  although  the  same  committee  had  previously  disap- 
proved of  it.  After  a  hard  struggle  the  bill  passed  the 
Legislature  and  became  a  law,  carrying  with  it  an  appro- 
priation of  $10,000. 

The  site  selected  for  the  institution  is  at  Huntington.  It 
is  the  intention  of  the  managers  of  the  Asylum  to  erect  at 
once  a  building  for  the  accommodation  of  deformed  and 
crippled  children,  and  to  construct  subsequently,  as  means 
will  allow,  a  building  specially  planned  for  epileptics  and 
another  for  idiots. 

Considering  the  aims  and  purposes  of  this  praiseworthy 
enterprise,  the  name  chosen  for  the  institution  is  singularly 
inappropriate.  To  commit  deformed  and  crippled  children 
or  epileptics,  many  of  whom  are  improvable,  if  not  curable, 
to  a  place  having  so  disheartening  a  designation  as  an 
Asylum  for  Incurables,  would  be  a  sad  mistake. 

The  Board  of  Managers  is  composed  of  influential  per- 
sons. Mrs.  Ruffner  is  President  of  the  Board  and  is  deeply 
interested  in  the  success  of  the  work. 


CHAPTER   VII. 

IOWA,  ILLINOIS,  CONNECTICUT,  VIRGINIA, 
CANADA. 


IOWA. 


THERE  is  no  special  provision  for  epileptics  in  Iowa. 
The  Institution  for  Feeble-Minded  Children  at  Glen- 
wood  has  a  population  of  760,  of  whom  about  twenty-five 
per  cent,  are  epileptics.     Superintendent  Powell  says: 

"  We  have  no  special  rooms  or  conveniences  set  apart  for 
epileptics.  It  is  true  we  have  classified  them  as  best  we 
could  with  our  present  arrangements,  but  I  anticipate  some- 
thing will  be  done  in  the  future  that  will  be  appropriate  for 
their  treatment  and  care.  A  bill  for  this  purpose  has  been 
before  our  Legislature,  but  after  passing  the  Assembly,  it 
was  lost  in  the  Senate. 

"  I  look  favorably  upon  the  plan  for  a  separate  colony  for 
epileptics,  not  from  direct  observation  of  its  results,  but 
from  more  than  a  dozen  years  of  continual  contact  with  one 
hundred  or  more  epileptics  commingling  with  the  more 
harmless  forms  of  mental  weakness,  and  from  reports  of 
colonies  of  this  character.  I  believe  the  time  is  near  at 
hand  when  Iowa  should  seriously  consider  special  provision 
for  this  deserving  class.  .  .  .  To  continue  to  house 
them  promiscuously  with  the  harmless  imbecile  is  unjust  and 
dangerous.  To  care  for  them  in  separate  or  detached  build- 
ings in  connection  with  institutions  for  feeble-minded  chil- 
dren will  require  such  extra  facilities  and  attention  as  to 


1 82  CARE  AND    TREATMENT  OF  EPILEPTICS. 

encumber  the  management  and  prevent  the  more  favorable 
results  obtainable  in  an  independent  colony." 

The  Board  of  Trustees  of  the  institution  of  which  Dr. 
Powell  is  the  able  Superintendent  entirely  coincide  with  his 
views  regarding  the  desirability  of  separating  epileptics  from 
the  feeble-minded.  The  superintendents  of  the  Iowa  hos- 
pitals for  the  insane  also  advocate  the  sequestration  of  this 
class  and  favor  the  colony  system.  The  claims  of  the  epi- 
leptic were  not  urged  upon  the  State  Legislature  of  1898, 
but  the  act  creating  the  Board  of  Control  of  State  Institu- 
tions enjoins  the  Board  to  encourage  and  urge  the  scientific 
investigation  of  the  treatment  of  insanity  and  epilepsy  by 
the  medical  staffs  of  the  hospitals  for  the  insane  and  the  in- 
stitution for  feeble-minded,  and  the  publication  from  time  to 
time  of  bulletins  and  reports  of  the  scientific  and  clinical  work 
done  in  said  institutions.  Several  of  the  medical  societies 
have  endorsed  the  colony  plan,  notably  the  Iowa  State  Med- 
ical Society  and  the  Medical  Society  of  the  Missouri  Valley. 

ILLINOIS. 

The  Board  of  Public  Charities  of  Illinois,  in  its  Biennial 
Report  presented  to  the  Governor  October  1,  1894,  estimated 
that  there  were  about  eight  thousand  epileptics  in  the  State, 
from  whom  the  ranks  of  dependent  epileptics  were  con- 
stantly recruited.  It  was  stated  in  the  same  report  that 
there  were  a  great  many  epileptics  in  the  hospitals  for  the 
insane  who  were  in  no  sense  insane,  and  whose  sufferings 
were  aggravated  by  being  considered  insane  and  classed  as 
such.  The  opinion  was  expressed  that  the  younger  cases 
in  the  almshouses  should  be  separated  from  the  ordinary 
almshouse  population  and  placed  where  they  could  have 
such  medical  care  as  might  mitigate  their  disease,  such  diet 
as   would    modify  their    seizures,  and    such    teaching   and 


ILLINOIS.  183 

occupation  as  they  could  profit  by.  Moreover,  it  was  thought 
that  the  epileptic  children  in  the  school  for  feeble-minded, 
of  whom  there  were  125,  should  receive  separate  care.  The 
Board  expressed  the  following  opinion:  "  The  most  careful 
examination  which  we  have  been  able  to  make  has  con- 
vinced us  that  for  the  general  care  of  epileptics  no  plan  has 
been  proposed  so  humane  and  so  scientific  as  the  colony 
plan."  This  opinion  was  coupled  with  the  recommenda- 
tion that  the  Legislature  at  once  appoint  a  committee  to 
select  a  suitable  site  for  an  epileptic  colony. 

The  Illinois  State  Medical  Society,  at  the  instance  of  Dr. 
J.  B.  Maxwell,  passed  a  resolution  emphatically  and  unquali- 
fiedly endorsing  the  scheme  for  such  a  colony  as  being 
"  humane,  practical,  and  necessary." 

In  its  report  presented  to  the  Governor  in  1896,  the  Board 
of  Public  Charities  urged  still  more  strongly  the  establishing 
of  a  colony  for  epileptics,  and  advised  the  purchase  of  at 
least  one  thousand  acres  of  land  for  such  an  institution.  In 
concluding  its   report    upon   this  subject  the  Board  said : 

We  urge  an  epileptic  colony,  first,  to  afford  protection, 
together  with  the  greatest  degree  of  freedom  consistent  with 
the  safety  of  the  inmates  and  society,  for  a  class  of  our 
population  now  suffering,  neglected,  and  too  often  a  public 
menace;  second,  to  provide  education,  training,  and  in- 
dustrial pursuits  for  all  who  can  be  taught  or  who  can  work ; 
third,  to  apply  the  best  medical  care  and  investigation  to 
the  study  of  epilepsy,  so  as  to  insure  such  alleviation  as  is 
possible  for  the  inmates,  so  as  to  obtain  and  diffuse  knowl- 
edge as  to  the  nature  and  prevention  of  this  disease,  and  so 
that  by  a  careful  study  of  the  influence  of  heredity  the 
people  may  be  fully  informed  of  the  responsibility  of 
parentage,  with  the  hope  that  the  future  burden  of  the 
State  and  society  may  be  lightened." 


1 84  CARE  AND    TREATMENT  OF  EPILEPTICS. 

A  bill  for  the  creation  of  an  epileptic  colony  was  pre- 
sented to  the  Legislature  in  the  early  part  of  1897,  but  failed 
to  become  a  law.  The  necessity  for  a  State  institution  for 
epileptics  in  Illinois  is  so  apparent  and  is  so  strongly  urged 
by  many  charitably  disposed  and  influential  citizens  that 
the  recommendations  of  the  Board  of  Public  Charities  and 
the  Illinois  State  Medical  Society  for  the  establishment  of 
such  an  institution  will  probably  ere  long  be  adopted  by 
the  Legislature. 

CONNECTICUT. 

No  special  provision  has  been  made  by  the  State  of  Con- 
necticut for  epileptics,  although  the  need  for  such  has  been 
felt.  In  the  Biennial  Report  of  the  trustees  of  the  Connect- 
icut Hospital  for  the  Insane  for  the  period  ending  June  30, 
1892,  attention  was  directed  to  the  fact  that  there  were 
ninety-six  epileptics  in  the  State  Hospital,  and  it  was  inti- 
mated that  Connecticut  might  derive  advantage  from  the 
establishment  of  a  village  colony  for  this  class  near  an  in- 
dustrial centre.  It  was  suggested  that  New  Haven  was 
especially  suitable  for  a  site,  because  of  its  proximity  to 
Yale  University  and  the  advantages  that  might  result  from 
affording  the  medical  staff  of  the  University  an  opportun- 
ity to  study  the  nervous  phenomena  presented  in  such  a 
colony.  There  are  in  the  State  many  epileptics  in  the 
almshouses  and  elsewhere  not  receiving  proper  care  and 
suffering  from  neglect.  A  few  epileptic  children  are  in  the 
excellent  institution  for  the  feeble-minded  conducted  by 
Dr.  George  H.  Knight  at  Lakeville. 

VIRGINIA. 

No  one  is  better  qualified  to  judge  of  the  needs  of  epi- 
leptics in  Virginia  than  Dr.  Wm.  Francis  Drewry,  Superin- 
tendent of  the  Central  State  Hospital  at  Petersburg.     The 


VIRGINIA.  185 

experience  he  has  had  with  this  unfortunate  class,  his  skill 
as  a  specialist  in  the  treatment  of  mental  diseases,  and  his 
humane  instincts,  which  have  led  him  into  extended  in- 
quiries respecting  epileptics,  eminently  fit  him  for  defining  a 
State  policy  for  their  care.  In  a  paper  read  by  Dr.  D  re  wry 
before  the  State  Medical  Society  of  Virginia  in  September, 
1895,  the  claims  for  a  special  institution  or  colony  for  this 
class  were  ably  set  forth. 

Dr.  Drewry  ascertained  that  there  were  115  epileptics  in 
the  three  hospitals  for  the  white  insane  in  Virginia  and  85 
in  the  hospital  for  the  colored  insane.  A  considerable  num- 
ber of  them  were  not  insane,  but  they  were  committed  to 
these  institutions  for  lack  of  suitable  places  to  receive  them. 
Through  persistent  correspondence  Dr.  Drewry  learned 
that  in  forty  out  of  sixty  counties  from  which  he  obtained 
returns  there  were  in  the  county  poorhouses  45  white  and 
53  colored  epileptics.  In  the  county  poorhouses  not 
heard  from  and  in  the  city  alsmhouses  he  estimated  that 
there  were  as  many  more.  In  order  to  arrive  at  something 
like  the  approximate  number  of  epileptics  outside  of  insti- 
tutions, Dr.  Drewry  sent  communications  to  two  hundred 
representative  physicians  distributed  in  every  county 
throughout  the  State,  asking  for  the  number  of  epileptic 
patients  in  their  respective  localities  and  the  probable  pro- 
portion to  the  general  population.  The  prevailing  opinion 
among  the  ninety-three  physicians  who  replied  was  that 
there  were  three  epileptics  to  every  one  thousand  of  the 
population,  or  nearly  five  thousand  in  the  entire  State.  Dr. 
Drewry  expressed  the  opinion  that,  at  a  low  estimate,  there 
were  not  less  than  three  thousand  in  the  State. 

Through  the  urgent  appeals  of  Dr.  Drewry  and  others 
interested,  the  Legislature  of  1895-96  passed  an  act  pro- 
viding for  the  appointment  of  a  commission  to  collect  data 


1 86  CARE  AND    TREATMENT  OF  EPILEPTICS. 

and  visit  institutions  and  colonies  in  other  States  and  report 
to  the  Legislature  of  1897-98  as  to  the  desirability  and 
feasibility  of  establishing  an  institution  for  epileptics  in  Vir- 
ginia. The  State  Medical  Society  subsequently  appointed 
a  committee  of  five  to  co-operate  with  the  commission  and 
urge  upon  the  Legislature  the  necessity  of  providing  State 
care  for  those  of  this  class  who  are  dependent.  The  com- 
missioners visited,  among  other  institutions,  the  Craig  Col- 
ony and  the  Ohio  Hospital  for  Epileptics  and  presented  a 
report  to  the  Legislature  in  January,  1898. 

The  commission  corroborated  the  statements  made  by 
Dr.  Drewry  in  his  very  instructive  address  to  the  State 
Medical  Society  as  to  the  condition  of  epileptics  in  the 
State  and  the  need  of  State  care  and  protection  for  them. 
It  reported  that  there  were  upwards  of  200  in  the  county  and 
city  almshouses,  in  the  hospitals  for  the  white  insane  225, 
and  in  the  hospitals  for  insane  negroes  95 ;  and  that  there 
were  certainly  3000  in  the  State  outside  of  any  institution, 
at  least  600  of  whom  were  totally  unable  to  earn  a  liveli- 
hood, or,  with  the  assistance  of  friends,  could  only  eke  out 
a  scanty  subsistence.  The  opinion  was  expressed  that  it 
would  ultimately  be  in  the  interest  of  public  economy  if 
the  State  would  assume  charge  of  all  indigent  epileptics  and 
provide  for  them  suitable  means  and  ways  by  which,  at  least, 
many  of  them  would  contribute  to  their  own  support.  It 
was  recommended  that  one  of  the  State  hospitals  be  utilized 
in  part  for  the  care  of  all  the  insane  white  epileptics  of  the 
State,  thus  leaving  two  other  hospitals  for  the  accommoda- 
tion of  all  white  insane  persons  not  epileptic,  and  that  suit- 
able buildings  should  be  set  apart  exclusively  for  epileptics 
not  insane,  so  that  their  diet  and  medical  treatment  could 
be  properly  regulated.  It  was  stated  that  this  policy  had 
been  adopted  at  the  Central  State  Hospital  at  Petersburg, 


VIRGINIA.  187 

where  all  the  female  colored  epileptics  occupy  a  separate 
building  constructed  especially  for  epileptics,  and  that  the 
results  were  satisfactory.  The  commission  recommended 
the  purchase  of  1000  acres  of  land  and  the  establishment 
of  a  colony,  and  that  the  expense  of  establishing  and  equip- 
ping the  colony  should  be  borne  exclusively  by  the  State, 
but  that  the  maintenance  should  be  paid  for  in  part  by  the 
various  counties  and  cities  sending  patients  there — say  $40 
per  annum  for  each  indigent  patient. 

The  commissioners  submitted  with  their  report  the  opin- 
ions of  Dr.  J.  D.  Moncure,  Superintendent  of  the  Eastern 
State  Hospital  at  Williamsburg,  Dr.  Benjamin  Blackford, 
Superintendent  of  the  Western  State  Hospital  at  Staun- 
ton, and  other  prominent  physicians  in  the  State  who  con- 
curred in  their  views.  Dr.  P.  A.  Irving,  Secretary  of  the 
State  Board  of  Health,  and  Dr.  Lewis  G.  Pedigo,  chair- 
man of  the  Epileptic  Committee  of  the  Medical  Society  of 
Virginia,  rendered  the  commission  valuable  service. 

The  report  was  favorably  received  by  the  Legislature. 
The  only  obstacle  in  the  way  of  carrying  out  the  recommen- 
dations of  the  commission  was  the  lack  of  means  in  the 
public  treasury.  The  same  commission  was  continued,  with 
instructions  to  present  to  the  next  Legislature  plans  and 
estimates  of  cost  for  a  colony  sufficient  to  meet  the 
present  pressing  demands. 

Much  spirit  is  manifested  in  this  movement  to  establish 
an  epileptic  colony,  and  it  is  believed  the  time  is  not  far 
distant  when  the  attempt  will  prove  successful.1  Virginia 
was  the  first  State  in  the  Union  to  establish  a  State  asylum 


1  In  a  paper  read  before  the  Tri-State  Medical  Society  of  the  Carolinas  and 
Virginia,  published  in  the  Charlotte  (N.  C.)  Medical  Journal  of  February, 
1899,  Dr.  Drewry  says :  "I  have  not  a  doubt  that  in  a  few  years  an  epileptic 
colony  will  be  established  in  Virginia." 


1 88  CARE  AND    TREATMENT  OF  EPILEPTICS. 

exclusively  for  the  insane,  and  the  first  State  or  country 
to  establish  a  public  institution  exclusively  for  the  colored 
insane.  It  is  not  likely  that  this  progressive  commonwealth 
will  be  remiss  in  making  needful  provision  for  her  epileptics. 

CANADA. 

The  Government  Inspector  of  Asylums  and  Prisons  of 
Ontario,  T.  F.  Chamberlain,  writes  respecting  the  care  of  epi- 
leptics: "  We  have  lately  been  considering  the  advisability 
of  having  an  institution  specially  for  the  care  and  treatment 
of  epileptics,  but  as  yet  nothing  definite  has  been  done." 
Dr.  Beaton,  Medical  Superintendent  of  the  Ontario  Asylum 
for  Idiots,  at  Orillia,  Canada,  has  in  the  institution  under 
his  charge  "about  140  epileptics  of  both  sexes  who  are 
not  admitted  as  such,  but  as  idiots  and  imbeciles.  Dr. 
Beaton  says  he  has  been  urging  upon  the  authorities  the  de- 
sirability of  establishing  a  colony  for  the  care  and  treatment 
of  this  class.  The  Ontario  Medical  Association  has  also 
recommended  the  Government  to  make  special  provision  for 
the  custodial  care  of  epileptics. 


CHAPTER   VIII. 
ENGLAND. 

PHILANTHROPISTS  in  England  have  become  aroused 
to  the  necessity  of  making  suitable  provision  for  epi- 
leptics, and  are  putting  forth  earnest  efforts  in  their  behalf. 
A  number  of  private  charities  for  their  relief  have  been 
established  during  the  past  twelve  years.  Only  recently 
has  any  special  institution  been  created  for  their  care  by 
public  authorities.  The  hope  is  now  entertained  that  the 
Government  may  be  influenced  to  supplement  the  com- 
mendable but  inadequate  work  of  private  benevolence,  by 
creating  district  colonies  for  this  class  under  the  direction 
and  control  of  County  Councils. 

Epileptics  who  are  insane  may  be  sent  to  the  insane 
asylums,  and  those  who  are  not  insane  may  be  admitted 
to  these  institutions  as  voluntary  patients,  and  are  some- 
times so  admitted,  but  this  is  not  done  frequently.  The 
only  public  provision  for  sane  epileptics  is  in  the  poor-law 
workhouses  and  infirmaries,  into  which  they  drift  in  com- 
mon with  other  destitute  persons.  In  the  great  city  of 
London  there  are  but  two  hospitals  where  they  are  even 
temporarily  treated.  One  of  these  is  the  National  Hospital 
for  the  Paralyzed  and  Crippled  in  Queens  Square,  Blooms- 
bury,  which  has  also  a  convalescent  home  where  epi- 
leptics are  received  and  maintained  for  a  few  weeks  after 
they  leave  the  hospital.  Most  of  the  charitable  institutions 
refuse  to  admit  them,  and  charity  workers  and  physicians 

189 


190  CARE  AND    TREATMENT  OF  EPILEPTICS. 

find  it  almost  impossible  to  obtain  employment  for  them. 
In  consequence,  those  suffering  from  epileptic  seizures  soon 
become  utterly  discouraged  and  despondent.  It  is  remark- 
able that  in  England,  where  so  much  has  been  done  for 
other  suffering  classes,  especially  the  insane,  so  little,  as 
compared  with  Germany,  has  been  accomplished  for 
epileptics. 

Within  recent  years  the  National  Society  for  the  Employ- 
ment of  Epileptics  and  the  London  School  Board  have 
directed  the  attention  of  the  Education  Department  to 
the  needs  of  dependent  epileptic  children,  with  the  result 
that  early  in  1897  a  committee  of  this  Department  was 
formed  to  inquire  into  and  report  upon  the  matter.  A  large 
number  of  distinguished  specialists  were  examined,  includ- 
ing members  of  the  medical  staff  of  the  National  Employ- 
ment Society;  its  Secretary,  G.  Penn  Gaskell ;  Mr.  Loch, 
of  the  Charity  Organization  Society ;  and  Dr.  W.  Alexan- 
der, of  the  Maghull  Home.  A  great  amount  of  evidence 
was  t^ken,  and  a  comprehensive  and  exhaustive  report  was 
made  on  the  subject  and  presented  to  both  Houses  of  Par- 
liament in  January,  1898.  The  committee  recommended 
legislation  which  should  place  on  school  boards  the  obliga- 
tion to  provide  for  the  education  and  maintenance  of  that 
large  class  of  epileptic  children  whose  seizures  are  so  fre- 
quent or  severe  as  to  prevent  their  attendance  at  the  ordi- 
nary day-schools.  It  would  be  left  to  the  school  authorities 
to  establish  and  maintain  proper  homes  of  their  own  or 
send  the  children  to  homes  already  established,  like  those  at 
Chalfont  St.  Peter.  This  policy  is  in  accord  with  the  views 
of  the  National  Employment  Society.  The  friends  of  epi- 
leptics are  anticipating  favorable  legislation  by  the  Govern- 
ment on  the  report  of  the  committee. 

Among   recent   evidences  of   an   awakening   interest   in 


HOME  FOR  EPILEPTICS,   MAGHULL.  191 

public  authorities  on  behalf  of  epileptics  is  the  project  of 
the  Boards  of  Guardians  of  Manchester  and  Chorlton  to 
establish,  on  what  is  known  as  the  Anderton  Hall  estate, 
near  Chorley,  an  asylum  on  the  colony  plan  for  harmless 
epileptics  and  imbeciles,  of  whom  there  are  about  six  hun- 
dred in  the  workhouses  of  these  two  unions.  The  site 
chosen  contains  about  237  acres,  valued  at  $100,000,  and  is 
about  twenty  miles  from  the  two  unions.  A  committee  ap- 
pointed by  the  joint  action  of  the  unions  named  has  visited 
Germany,  Belgium,  and  France  and  examined  the  institu- 
tions for  the  care  of  the  above-mentioned  classes  in  those 
countries.  The  Local  Government  Board  has  approved  the 
enterprise. 

HOME    FOR    EPILEPTICS,    MAGHULL. 

The  Home  for  Epileptics  at  Maghull,  about  seven  miles 
from  Liverpool,  in  the  valley  of  the  Mersey,  was  the  first 
institution  of  its  kind  founded  in  England.  It  was  estab- 
lished in  1888  through  the  benefactions  of  Mr.  Henry  Cox, 
of  Liverpool,  and  aid  rendered  by  Dr.  William  Alexander 
and  others  of  that  city.  The  work,  begun  somewhat  as  an 
experiment,  proved  a  success,  and  stimulated  efforts  in  the 
same  direction  elsewhere. 

The  institution  occupies  a  quiet  and  secluded  site  adjoin- 
ing a  pleasant  park,  and  about  it  are  neatly  trimmed  lawns 
and  shade  trees.  There  are  but  forty-one  acres  of  land 
connected  with  the  Home,  fourteen  of  which  are  leased  for 
meadow  and  grazing.  The  remainder  is  used  for  raising 
fruit,  for  gardening,  and  for  recreation  grounds. 

The  building  occupied  by  women  is  a  spacious  manor- 
house,  with  many  large  windows  having  attractive  out- 
looks.    This  was  the  nucleus  of  the  institution,  to  which 


I92  CARE  AND    TREATMENT  OF  EPILEPTICS. 

other  structures  have  been  added,  including  a  large  build- 
ing for  men  and  a  hall  for  concerts  and  entertainments. 

The  affairs  of  the  Home  are  directed  by  a  "  Committee," 
the  members  of  which  are  elected  by  subscribers  who  con- 
tribute one  guinea  or  more  annually.  A  contribution  of 
^500  in  one  sum  guarantees  the  use  of  a  free  bed  for 
life.  In  addition  to  a  local  medical  officer  the  medical  staff 
consists  of  three  consulting  physicians,  an  oculist,  and  a 
dental  surgeon.  The  establishment  is  in  the  immediate 
charge  of  a  matron.  Subordinate  to  her  are  two  assistants 
and  a  staff  of  women  nurses,  three  of  whom  are  trained. 
The  others  are  probationers.  There  is  also  an  outdoor 
superintendent,  with  assistants. 

At  the  date  of  March  4,  1899,  there  were  121  patients  in 
the  Home,  68  of  whom  were  males  and  53  females.  At  the 
same  time  70  applicants  were  waiting  for  admission.  Epi- 
leptics deemed  dangerous  to  themselves  or  others  are  not 
received.  Those  becoming  insane  are  transferred  to  an 
insane  asylum  or  returned  to  their  friends.  The  Home  is 
supported  by  voluntary  subscriptions  and  payments  for 
board  and  care  of  patients.  For  those  sent  by  Guardians 
of  the  Poor  the  usual  charge  is  ?s.  6d.  a  week.  The  prices 
charged  to  private  patients  vary  according  to  the  accom- 
modations furnished.  These  are  admitted  voluntarily  and 
may  leave  at  their  discretion.  Every  effort  is  made  to 
keep  the  inmates  suitably  employed,  the  managers  and 
medical  officers  believing  this  to  be  all-important.  Instruc- 
tion is  given  in  basket-making  to  some  of  the  patients, 
both  male  and  female ;  and  a  few  of  the  men  work  in  the 
joiner's  shop.  The  men  are  principally  employed,  how- 
ever, under  the  outdoor  superintendent  at  gardening  and 
in  looking  after  the  farm  stock.  The  women  are  mostly 
occupied  with  the  laundry  and  domestic  work  of  the  two 


MANOR    HOUSE    FOR    WOMEN    'Maghull   Home). 


BUILDING    FOR    MEN    (Maghull   Home). 


HOME  FOR  EPILEPTICS,   MAGHULL.  1 93 

buildings  and  their  own  sewing,  knitting,  and  fancy  work. 
With  few  exceptions,  and  these  principally  among  the  new- 
comers, all  the  patients  do  their  work  willingly. 

As  a  means  of  amusement,  cricket,  tennis,  bowls,  and 
hockey  are  freely  engaged  in  during  the  summer;  while 
music,  and  bagatelle,  whist,  chess,  draughts,  dominoes,  and 
other  games,  occupy  the  winter  evenings.  There  are  also 
entertainments  every  week  during  the  winter,  including 
concerts  and  magic-lantern  exhibitions,  which  are  provided 
by  residents  of  Liverpool.  The  patients'  minstrel  choir 
furnishes  at  times  musical  entertainments,  to  which  the 
outside  friends  of  the  patients  are  invited. 

Religious  services  are  conducted  every  Sunday,  and  the 
spiritual  aspirations  of  the  inmates  are  not  neglected. 

Respecting  the  results  of  treatment  in  this  institution, 
the  physicians  say:  "  We  have  analyzed  the  records  of 
all  the  female  patients  who  have  entered  the  Home  since  its 
commencement.  The  entire  number  is  108.  Ten  of  these 
improved  so  much  that  the  attacks  had  disappeared  at  the 
time  of  the  last  record  for  periods  ranging  from  a  month  to 
two  years;  twenty- four  had  improved  very  much,  the  at- 
tacks diminishing  by  more  than  fifty  per  cent,  in  all  of 
these  cases,  and  in  some  cases  having  almost  entirely  dis- 
appeared; thirty-seven  improved,  the  attacks  being  les- 
sened; in  seventeen  the  number  remained  stationary;  in 
fourteen  the  number  of  attacks  increased  during  their  stay 
at  the  Home;  and  six  stayed  too  short  a  time  for  any 
change  to  take  place. 

"  In  thirty-three  of  the  female  patients  the  disease  began 
before  the  sufferers  reached  the  age  of  ten  years;  in  thirty- 
two  between  the  ages  of  ten  and  twenty  years ;  in  five  be- 
tween the  ages  of  twenty  and  thirty  years;  and  in  three 
between  the  ages  of  thirty  and  forty  years. 


194  CARE  AND    TREATMENT  OF  EPILEPTICS. 

"  The  statistics  seem  to  show  that  epilepsy  is  more  per- 
sistent and  intractable  among  females  than  males,  but  the 
difference  may  be  due  to  the  fact  that  female  epileptics  are 
not  sent  to  us  until  they  have  been  a  long  time  ill,  as  they 
are  not  only  more  amenable  to  home  treatment  than  males, 
but  parents  dislike  more  to  part  with  them  than  with  the 
opposite  sex." 

At  the  close  of  December,  1896,  an  analysis  was  also 
made  of  the  records  of  170  male  patients  who  had  been 
admitted  to  the  Home  since  its  opening. 

"In  no  cases  that  received  treatment  in  the  institution 
the  attacks  were  lessened  in  number,  and  in  16  cases  the 
number  of  attacks  increased.  Thirty  cases  remained  sta- 
tionary, and  12  patients  died. 

"  Of  the  1 10  cases  that  improved,  53  improved  very  much 
indeed,  the  attacks  having  practically  disappeared.  In  27 
cases  the  number  of  attacks  was  reduced  by  one  third,  in  16 
cases  the  attacks  were  reduced  by  one  half,  and  in  10  cases 
by  two  thirds  of  their  number." 

In  consequence  of  the  constant  care  and  watchfulness  ex- 
ercised over  the  patients,  no  serious  injuries  had  occurred 
and  but  very  few  had  suffered  from  bruises. 

The  medical  officers  say:  "  So  far  as  medicine  can  relieve 
the  condition  the  patients  are  relieved,  but  not  at  the  ex- 
pense of  health,  strength,  and  happiness,  as  is  exemplified 
again  and  again  in  the  miserable  wrecks  we  occasionally  re- 
ceive, whose  well-being  has  been  sacrificed  and  whose  lives 
have  been  endangered  by  being  dosed  by  one  or  other  of  the 
quack  remedies  advertised  in  the  papers." 

An  instance  is  related  of  "  a  boy  fourteen  years  of  age, 
who  was,  when  admitted,  very  thin  and  delicate-looking, 
but  without  any  organic  disease.  He  had  been  taking  a 
widely  advertised  remedy  for  two  years,  and  with  it  had 


NATIONAL  EMPLOYMENT  SOCIETY.  195 

four  attacks  of  grand  Dial  a  month,  and  twenty  of  petit 
mal  a  day.  He  was  nearly  poisoned  with  bromides.  On 
his  admission  to  the  Home  the  quack  medicine  was  of 
course  stopped,  and  the  boy  broke  down  just  as  an  inveter- 
ate tippler  breaks  down  when  his  favorite  stimulant  is  with- 
held. As  soon  as  the  collapse  had  passed  away,  the  boy 
recovered,  and  is  now  a  plump,  bright  lad." 

The  medical  officers  do  not  apply  the  word  "  cured  "  to 
their  patients  until  a  long  period  has  elapsed  after  a  seizure, 
deeming  the  phrase  "  cessation  of  attacks,"  more  applicable 
to  their  condition. 

Dr.  Alexander  notes  that  the  practical  success  of  the  in- 
stitution, from  a  medical  standpoint,  has  been  abundantly 
established  by  its  medical  records;  and  furthermore,  that 
the  inmates  have  taken  a  new  interest  in  life,  that  a  good 
many  have  been  taught  to  work  regularly,  and  that  all  have 
been  made  a  great  deal  happier. 

NATIONAL   SOCIETY    FOR    THE    EMPLOYMENT    OF    EPILEPTICS. 

At  a  meeting  of  the  Charity  Organization  Society  of  Lon- 
don, held  July  4,  1890,  a  special  committee  was  appointed 
"  to  consider  and  report  upon  the  public  and  charitable  pro- 
vision made  for  the  care  and  training  of  feeble-minded,  epi- 
leptic, deformed,  and  crippled  persons."  This  committee 
was  composed  of  representatives  of  the  British  Medical 
Association  and  of  many  charitable  institutions,  together 
with  Poor-Law  Guardians,  and  others  specially  conversant 
with  this  question. 

The  committee  made  an  extended  inquiry  into  the  con- 
dition and  needs  of  the  classes  named,  and  collected  and 
submitted  to  the  Charity  Organization  Society  a  vast 
amount    of   valuable    information    respecting   them.      The 


I96  CARE  AND    TREATMENT  OF  EPILEPTICS. 

results  of  this  inquiry  were  given  to  the  public  by  the  So- 
ciety through  the  publications  of  the  "Charity  Organiza- 
tion Series."  The  facts  and  conclusions  submitted  by  the 
committee  attracted  wide  attention.  Especially  did  their 
work  bring  into  strong  relief  the  necessity  for  further 
and  better  provision  for  persons  afflicted  with  epilepsy.  It 
was  estimated  that  there  were  upwards  of  thirty  thousand 
sane  epileptics  in  Great  Britain.  A  particular  inquiry  made 
into  the  circumstances  of  many  of  them  revealed  the  fact 
that  large  numbers  had  lost  their  situations  and  could  find 
no  employment  in  consequence  of  their  infirmity;  that 
others  only  occasionally  could  find  brief  seasons  of  employ- 
ment, and  great  numbers  were  obliged  to  spend  their  lives 
in  idleness. 

As  a  result  of  many  meetings  of  the  committee,  which 
were  attended  by  leading  physicians  and  others  interested 
in  the  subject,  an  executive  committee  was  constituted  for 
the  purpose  of  making  an  appeal  for  funds  to  establish 
homes  where  sane  epileptics  could  be  provided  with  em- 
ployment. On  January  25,  1893,  a  large  public  meeting 
was  held  at  the  Mansion  House,  at  which  the  Lord  Mayor 
presided.  Addresses  were  made  by  the  late  Sir  Andrew 
Clark,  M.D.,  Sir  James  Crichton  Browne,  Mr.  C.  S.  Loch, 
and  others.  Sir  Andrew  Clark,  in  giving  voice  to  his  con- 
victions respecting  provision  for  this  class,  said :  "  If  we  can 
occupy  them  in  regular  work,  bring  them  together  in  a  well- 
regulated  colony  which  will  revive  their  flagging  sympathies, 
reawaken  their  affections,  and  call  forth  by  growth  and  de- 
velopment all  those  qualities  in  men  and  women  which  make 
up  our  higher  life, — if  all  this  can  be  accomplished,  I  am 
convinced,  from  every  conceivable  consideration,  not  only 
that  this  work  is  well  worth  doing,  but  that,  as  a  serious 
duty,  it  ought  to  be  done." 


NATIONAL  EMPLOYMENT  SOCIETY.  1 97 

The  following  resolution  was  passed  at  the  meeting: 

"  That  it  is  expedient  to  establish  in  England  a  colony 
for  epileptics  capable  of  work,  on  the  same  lines,  as  far  as 
circumstances  shall  render  advisable,  as  the  industrial  col- 
onies successfully  carried  on  near  Bielefeld  in  Germany,  and 
elsewhere." 

Following  the  passage  of  this  resolution  numerous  liberal 
subscriptions  were  announced  amounting  to  ^"2500.  A 
note  was  also  read  from  Mr.  Passmore  Edwards  enclosing  a 
check  for  ,£1000  as  an  advance  payment  towards  the  pur- 
chase of  a  suitable  farm  for  the  proposed  colony.  Upon  this 
basis  the  National  Society  for  the  Employment  of  Epi- 
leptics was  organized. 

The  Society  is  governed  and  controlled  by  a  council  hav- 
ing an  executive  committee  and  subordinate  committees 
and  officers  to  direct  the  details  of  its  operations.  The 
members  of  the  council  are  elected  annually  by  the  gover- 
nors of  the  Society.  The  payment  of  one  guinea  or  up- 
wards yearly  to  the  Society  makes  the  contributor  a  gov- 
ernor, or  the  payment  of  ten  guineas  or  more  in  one  sum  a 
governor  for  life.  "  The  object  of  the  Society  is  to  es- 
tablish homes  where  persons  suffering  from  epilepsy,  yet 
capable  of  some  occupation,  may  enjoy  the  advantages  of 
regular  life  with  healthy  surroundings,  and  where,  under  the 
necessary  supervision,  they  may,  according  to  their  age, 
sex,  and  condition,  be.  educated,  industrially  trained,  or 
suitably  employed." 

It  is  intended  that  the  homes  shall  be  supported  by  pay- 
ments made  by  the  inmates,  their  friends,  guardians,  or 
poor-law  authorities,  according  to  the  accommodations  fur- 
nished ;  also  by  the  proceeds  of  industries  of  the  homes 
and  by  endowments,  bequests,  subscriptions,  and  voluntary 
contributions.     It  is  hoped  that  a  maintenance  fund  can 


I98  CARE  AND    TREATMENT  OF  EPILEPTICS. 

be  established,  in  order  that  persons  unable  to  make  or  pro- 
cure the  necessary  payments  may  be  supported. 

After  examining  many  properties,  a  farm  at  Chalfont  St. 
Peter,  containing  135  acres,  was  selected  and  purchased  in 
1893.  It  is  situated  amidst  surroundings  of  natural  beauty, 
in  a  salubrious  climate,  about  four  hundred  feet  above  sea- 
level.  It  is  easily  accessible  from  London,  from  which  it  is 
within  convenient  carting  distance  for  the  disposal  of  pro- 
duce, and  the  distance  from  any  large  town  is  sufficient  to 
afford  seclusion  to  the  patients.  The  water-supply  is  pure 
and  abundant.  The  soil  of  the  farm  is  eminently  adapted  to 
spade  cultivation,  even  in  the  wet  season  of  the  year,  and 
to  fruit-growing  and  market-gardening.  Most  of  the  land 
belonging  to  the  colony  is  devoted  to  farming  purposes,  but 
a  considerable  portion  is  set  apart  for  fruit-growing,  raising 
vegetables,  and  for  general  gardening.  One  of  the  first 
things  the  managers  did  after  coming  into  possession  of  the 
property  was  to  plant  a  goodly  acreage  with  fruit  trees. 

The  first  building  erected  at  the  colony  was  the  Alpha 
House — an  iron  structure  capable  of  accommodating  eigh- 
teen colonists  besides  the  staff-officers.  It  was  completed 
and  other  arrangements  perfected  so  that  Chalfont  St.  Peter 
was  opened  for  patients  on  August  1,  1894.  The  following 
extract  from  the  report  of  the  executive  committee  pre- 
sented at  the  first  annual  meeting  of  the  governors,  May  27, 
1895,  sets  forth  the  wise  policy  adopted  at  the  very  outset: 

"  Our  aim  in  the  management  of  the  colony  has  been 
to  avoid  everything  which  would  stamp  it  with  an  '  insti- 
tutional '  character.  It  will,  indeed,  at  a  later  stage,  when 
fully  developed,  not  only  be,  in  a  certain  sense,  a  hospi- 
tal and  a  sanatorium,  but  it  will  be  far  more  than  this.  It 
will  be  an  industrial  village,  whose  inhabitants,  though  un- 
happily afflicted,  will  be  usefully  and  healthfully  occupied, 


CHALFONT  ST.    PETER.  I99 

and  will,  as  far  as  possible,  follow  the  avocations  of  ordinary 
life.  We  seek  in  our  little  world  at  Chalfont  St.  Peter  to 
imitate  the  great  world  outside,  and  our  hope  is  that  the 
colony  will  grow  into  a  thriving  and  well-ordered  com- 
munity, where  the  colonists  will  be  united  by  ties  analogous 
to  those  which  bind  men  together  as  members  of  a  family, 
as  neighbors,  and  as  citizens,  with  the  superadded  sense  of 
fellowship  arising  from  the  consciousness  of  their  common 
affliction.  With  this  object  in  view  we  began  taking  only 
three  or  four  men  at  first  to  form  the  foundation  of  a  family, 
and  receiving  others  singly  or  two  at  a  time.  Even  at  the 
end  of  the  first  five  months  the  little  home  was  not  quite 
filled  up.  This  method  was  an  expensive  one,  but  we  are 
far  from  regretting  the  cost,  for  so  firm  a  basis  of  brother- 
hood and  family  feeling  has  now  been  laid  that  this  extreme 
caution  will  not  be  necessary  in  the  future.'' 

Before  the  close  of  the  year  1894  the  foundation  of  a 
brick  building  planned  to  accommodate  eighteen  colonists 
and  to  cost  between  ^1500  and  .£1600  was  laid,  and  the 
structure  was  completed  in  1895.  It  is  called,  from  the 
name  of  its  founder,  the  Passmore  Edwards  House.  A  brick 
building  was  partially  erected  in  1894  for  a  workshop  and 
storehouse,  upon  which  some  of  the  colonists  were  em- 
ployed in  bricklaying,  carpentering,  painting,  and  other 
work.  In  the  early  part  of  1896,  through  the  generous  gift 
of  Mr.  Passmore  Edwards  for  the  express  purpose,  a  home 
to  accommodate  twenty-four  women  was  begun,  and  fin- 
ished the  following  year.  Prior  to  its  completion  the 
Victoria  House  for  twenty-four  men  was  begun,  and  on 
May  6,  1897,  there  was  a  happy  manifestation  of  that  co- 
operative sympathy  in  human  suffering  which  knows  no 
limitation  by  oceans  or  nationalities.  To  Mr.  Bayard  was 
extended  the  honor  of  participating  in  the  extension  of  a 


200  CARE  AND    TREATMENT  OF  EPILEPTICS. 

beautiful  charity.  The  last  public  act  of  the  American 
Minister  before  leaving  England  was  the  laying  of  the  foun- 
dation-stone of  the  Victoria  House.  Mrs.  Bayard  also  took 
part  in  the  interesting  ceremonies  by  opening  the  women's 
home  and  planting  an  American  oak  as  a  memorial.  This 
house  is  appropriately  named  the  Eleanor  House,  after  Mrs. 
Passmore  Edwards. 

A  recreation-hall,  the  gift  of  a  friend,  was  also  completed 
the  same  year.  This  is  a  building  of  goodly  size,  with 
separate  entrances  for  men  and  women,  and  is  used  for 
concerts  and  various  kinds  of  entertainments. 

There  is  nearing  completion  a  small  hospital  building,  in 
which  are  two  wards  for  men  and  women  respectively ;  two 
single  rooms  for  patients  requiring  rest  and  quiet ;  and  two 
padded  rooms,  which  it  has  been  thought  prudent  to  pro- 
vide, though  it  is  anticipated  that  they  will  be  very  rarely 
used. 

The  following  is  an  enumeration  of  all  the  homes,  with 
the  capacity  of  each : 

Passmore  Edwards  House for  18  men. 

Victoria  House "    24 

Greene  Home "    24 

Eleanor  House "    24  women. 

Milton  House "    24  boys. 

A  Home  (not  yet  named) "    24  girls. 

Dearmer  Home  (the  little  hospital  already  men- 
tioned), with  accommodations  for  five  men  and 
five  women. 

In  addition  to  the  above  homes,  there  are  workshops, 
a  laundry,  recreation-hall,  farmhouse,  and  other  farm  build- 
ings. The  laundry,  built  during  the  last  year,  is  a  well- 
lighted,  airy  building  of  red  brick,  with  tiled  roof.  It  was 
constructed  almost  entirely  by  the  patients,  working  under 


O       O 


CHALFONT  ST.   PETER.  201 

the  direction  of  the  bailiff.  The  Alpha  House  is  now  used 
as  a  kitchen  for  the  whole  colony,  and  also  for  workshops. 
The  need  of  additional  workshops  has  long  been  felt.  The 
managers  say:  "  Hitherto,  when  the  weather  has  made  it 
unfit  to  work  out-of-doors,  it  has  been  difficult  to  occupy 
the  patients  usefully,  and  there  are  always  some  colonists  to 
whom  indoor  work  seems  more  suitable  than  field  work." 

Respecting  the  needs  of  epileptic  boys  fourteen  years  of 
age  and  upwards,  for  whom  limited  provision  is  now  made, 
the  committee  says:  "At  an  age  when  most  boys  begin  to 
earn  something,  they  have  to  remain  ;  .  home  in  idleness, 
and  they  have  outgrown  entirely  the  control  of  the  mother. 
The  father  is  usually  away  all  day,  and  the  ordinary  result 
is  a  course  of  spoiling  and  indulgence,  induced  partly  by 
pity  for  the  afflicted  boy,  but  sometimes  by  fear  of  causing 
a  fit.  The  sight  of  this  over-indulgence  as  well  as  of  the 
fits  is  bad  for  the  younger  children.  Such  boys  need  a 
firm  hand  and  patient  but  absolute  discipline  to  build  up 
the  already  defective  brain  and  will ;  but,  in  fact,  they  grow 
up  too  often  quite  untrained,  and  at  a  critical  age,  when 
mind  and  body  are  rapidly  growing  and  are  liable  to  take 
any  bent,  they  live  entirely  uncontrolled  and  self-indulgent 
lives,  and  destroy — with  the  aid  of  those  who  love  them 
best — any  chance  of  cure,  or  of  keeping  the  mind  sound  in 
spite  of  the  fits.  The  committee  feel  that  in  taking  even  a 
few  of  these  cases  there  will  be  a  most  hopeful  work  accom- 
plished. The  daily  life  of  these  boys  must  be  different 
from  the  routine  of  the  men,  and  it  should  include  some 
education  as  well  as  suitable  training  in  work.  It  has, 
therefore,  been  considered  impossible  to  take  them  until 
they  could  have  a  separate  home." 

The  different  buildings  and  departments  of  the  colony  are 
in   telephonic    communication.     The    sleeping-rooms    are 


202  CARE  AND    TREATMENT  OF  EPILEPTICS. 

thoroughly  ventilated  during  the  day,  as  they  are  occupied 
only  at  night.  Each  dormitory  contains  nine  or  twelve  beds, 
and  in  every  house  two  dormitories  are  so  arranged  that 
an  attendant  or  nurse  occupying  an  adjoining  room  can 
overlook  both  dormitories.  This  arrangement  is  thought 
to  be  better  than  the  method  of  having  attendants  or 
nurses  on  regular  night  duty,  as  the  latter  tends  in  a  much 
greater  degree  to  remind  the  patients  of  their  affliction. 
There  is  a  room  in  each  house  for  those  suffering  from 
any  temporary  ailment.  Food  is  supplied  from  a  general 
kitchen,  and  is  conveyed  to  the  different  houses  on  hospital 
trolleys. 

The  indoor  affairs  of  the  colony  are  directed  by  a  matron, 
who  is  a  trained  nurse.  A  Sister  has  charge  of  each  home, 
and  is  assisted  in  the  care  of  the  men's  homes  by  a  male 
attendant  and  in  the  care  of  the  women's  home  by  a  nurse. 
Some  of  the  Sisters  are  trained  nurses,  but  previous  educa- 
tion as  such  is  not  deemed  essential.  Those  untrained  are 
brought  under  a  system  of  instruction  at  the  institution. 
The  male  attendants,  in  all  cases,  are  retired  soldiers,  and 
had  no  preparation  for  this  special  work  before  enter- 
ing the  colony.  A  bailiff,  who  is  a  builder  as  well  as  a 
farmer,  has  charge  of  affairs  out-of-doors.  A  gardener  is 
employed,  as  are  also  a  few  paid  laborers. 

The  means  of  supplying  water  to  the  homes  have  been 
improved  recently  by  substituting  two  oil-engines  for  horse- 
power. 

The  pressure  for  admission  still  continues.  Under  date 
of  March  3,  1899,  Secretary  Gaskell  writes:  "  The  appli- 
cants for  admission  greatly  exceed  our  accommodation,  and 
this  is  one  of  our  great  difficulties,  for  it  results  in  every 
candidate  having  to  wait  a  long  time — often  two  years — 
before  admission,  and  during  this  interval,  in  most  instances, 


PASSMORE    EDWARDS    HOUSE    <  Chalfont  St.    Peter). 


VICTORIA    HOUSE   'Chalfont  St.   Peter1 


CHALFONT  ST.   PETER.  203 

the  malady  becomes  confirmed  and  consequently  less  hope- 
ful from  a  remedial  point  of  view." 

Patients  are  not  committed  to  the  colony  by  statute,  but 
enter  it  voluntarily.  Insane  epileptics  are  not  received,  and 
patients  becoming  insane  are  transferred  elsewhere. 

The  present  maximum  charge  for  treatment  and  mainte- 
nance is  ten  shillings  a  week.  This  sum  is  never  reduced 
in  poor  -  law  cases,  but  in  all  others  each  applicant  is 
dealt  with  individually,  and  if  the  relatives  are  unable  to 
afford  ten  shillings  a  week,  but  are  willing  to  do  their 
utmost  to  pay  such  amount  as  they  are  able,  the  charge 
is  reduced ;  and  this  is  done  the  more  readily  when 
local  charity  interests  itself  in  the  case  and  contributes 
something  towards  the  maintenance  of  the  applicant,  it 
being,  in  the  opinion  of  the  committee,  a  matter  of  the 
utmost  importance  to  stimulate  and  encourage  local  interest 
in  these  afflicted  cases.  There  are  at  present  only  third- 
class  accommodations,  but  ^5000  have  been  recently  given 
to  the  Society  by  an  anonymous  donor  for  the  purpose  of 
providing  for  a  few  first-class  patients. 

The  dietary  is  regulated  by  the  matron  with  the  advice 
of  the  visiting  physicians.  Milk  produced  on  the  place  is 
liberally  supplied,  and  fruit  from  the  trees  now  growing  is 
expected  to  be  a  helpful  factor  in  the  dietary.  The  use  of 
stimulating  liquors  is  forbidden  at  the  colony,  and  dis- 
countenanced when  patients  visit  their  friends. 

The  usual  working-time  is  about  seven  hours  a  day, 
except  during  the  short  days  of  winter.  The  time  devoted 
to  work  in  individual  cases  is  subject  to  the  limitation  of 
the  physician.  It  is  explained  to  the  colonists  on  admission 
that  each  is  expected  to  perform  such  kind  of  work  as  may 
be  required,  including  laundering,  in  case  it  is  not  consid- 
ered prejudicial  by  the  physician.     The  managers  say  they 


204  CARE  AND    TREATMENT  OF  EPILEPTICS. 

are  "  more  and  more  convinced  of  the  truth  of  the  Gospel 
of  Work  for  the  colonists;  even  the  relaxation  of  Christmas 
and  Easter  brings  an  increase  of  irritability  and  of  fits." 

The  regulations  respecting  work  are  not  such  as  to  stand 
in  the  way  of  affording  ample  opportunities  for  varied  out- 
door and  indoor  recreation. 

Church  of  England  service  and  services  of  non-conformists 
are  held  at  the  colony  weekly,  and  patients  are  allowed  to 
attend  divine  worship  in  the  village  near  by.  It  is  aimed 
to  afford  religious  privileges  to  every  inmate  of  whatever 
denomination. 

The  management  is  to  be  congratulated  upon  the  whole- 
some moral  influence  attending  the  system  of  administra- 
tion. It  is  asserted  that  "  the  good  feeling  which  prevails 
among  the  men,  notwithstanding  occasional  bickerings, 
is  indeed  the  most  satisfactory  feature  of  the  colony ;  but 
in  many  other  respects  the  progress  made  is  most  en- 
couraging. It  is  particularly  pleasing  to  observe  how 
rapidly,  under  the  influence  of  improved  moral  health  and 
new  interest  in  life,  the  sluggishness  and  apathy  which 
almost  invariably  characterize  the  colonists  on  arrival  are 
replaced  by  brightness,  energy,  and  alertness." 

In  summing  up  the  work  at  Chalfont  St.  Peter,  one  in- 
terested in  it  says  that  useful,  active,  social,  and,  in  most 
cases,  happy  lives  have  been  made  out  of  lives  that  were  a 
misery  to  themselves  and  a  source  of  suffering  to  others; 
and  anxious  relatives  have  been  enabled,  without  any  loss 
of  self-respect,  to  place  those  dear  to  them  in  circumstances 
much  more  favorable  to  health  and  comfort  than  can  ever 
be  possible  in  the  ordinary  home  circle. 

THE  MEATH  HOME  OF  COMFORT. 

The  Meath  Home  of  Comfort  was  established  in  1892. 


MEATH  HOME    OF  COMFORT.  205 

The  work  originated  with  the  Countess  of  Meath,  whose 
sympathy  for  epileptics  had  become  deeply  aroused  by 
their  suffering  and  neglected  condition.  In  1890  she  visited 
the  celebrated  colony  near  Bielefeld,  and,  upon  her  return  to 
England,  determined  to  establish  a  similar  home  for  women 
and  girls.  Eventually  the  Countess  found  an  old  family 
mansion  suitable  for  her  purpose  at  Godalming,  in  a  beauti- 
ful part  of  Surrey.  She  purchased  the  property,  repaired 
the  buildings,  introduced  modern  improvements,  and 
furnished  the  Home  completely  for  about  sixty  patients. 
There  are  now  accommodations  for  upwards  of  eighty. 
The  grounds  about  the  Home  are  very  attractive,  with 
drives  and  walks,  stretches  of  carefully  kept  lawn,  and 
grand  old  trees. 

When  everything  was  ready  for  the  reception  of  bene- 
ficiaries the  property  was  placed  in  the  hands  of  trustees, 
and  the  work  of  the  institution  was  given  in  charge  of  a 
committee. 

The  Home  was  opened  with  impressive  ceremonies,  at 
which  the  founder  gave  a  short  account  of  the  colony  near 
Bielefeld,  and  made  an  earnest  appeal  for  the  support  of  the 
Home,  which  is  sustained  by  voluntary  subscriptions  and 
charges  for  boarding  patients.  The  inmates  are  divided 
into  two  classes.  Those  who  are  accommodated  in  large 
dormitories  pay  at  the  rate  of  \2s.  6d.  a  week;  the  others 
pay  from  £1  is.  to  £2  2s.  a  week,  and  have  greater 
privileges,  including  a  sitting-room  of  their  own. 

Female  epileptics  between  the  ages  of  two  and  thirty-five 
years  are  received.  Violent,  hysterical,  imbecile,  or  lunatic 
cases,  kleptomaniacs,  or  those  who  are  insubordinate  or  of 
low  character  are  ineligible.  The  object  of  the  institution 
is  not  to  provide  for  those  who  are  in  an  advanced  stage 
of  epilepsy,  but  rather  to  afford  a  happy  home  for  those 


206  CARE  AND    TREATMENT  OF  EPILEPTICS. 

whose  condition  may  be  improved,  or  who  may  possibly  be 
cured,  and  who  are  capable  of  being  usefully  employed. 

The  Superintendent  is  a  fully  qualified  nurse,  who  is  as- 
sisted by  a  staff,  all  of  whom  have  had  hospital  training. 
The  children  are  in  charge  of  a  governess. 

All  the  patients  are  expected  to  do  whatever  work  the 
Superintendent  may  require  of  them.  The  two  classes 
meet  and  work  harmoniously  together;  and  when  the  adults 
are  sitting  in  the  shade  of  the  trees  making  baskets,  or  the 
children  are  having  a  good  game  on  the  lawn,  it  is  difficult 
to  imagine  that  they  are  so  sadly  afflicted.  The  fact  that 
constant  and  varied  employment  has  been  devised  for  the 
patients  has  contributed  largely  to  the  success  of  the  under- 
taking. Every  inmate  is  encouraged  to  take  an  interest 
in  the  Home  and  share  in  its  duties  and  responsibilities. 
Each  makes  her  own  bed  and  assists  in  the  general  house- 
work. Some  aid  in  preparing  vegetables  for  the  table, 
some  work  in  the  laundry.  Many  are  excellent  needle- 
women. The  variety  of  plain  and  fancy  needlework, 
basketwork,  and  knitted  articles  made  by  the  inmates  of 
this  institution  prevents  monotony  in  occupation.  The 
needlework  includes  the  making  of  women's  and  children's 
underwear,  aprons,  dresses,  and  hot-water-can  cosies.  The 
knitted  articles  include  socks,  stockings,  gloves,  ladies' 
and  boys'  vests,  petticoats,  dish-cloths,  and  bags  for  tennis- 
balls.  The  basketwork,  which  is  particularly  interesting, 
includes  the  making  of  a  great  variety  of  covers  for  glass 
bottles,  flower-baskets,  garden-baskets,  market-baskets, 
egg-baskets,  waste-paper  baskets,  work-baskets,  knitting- 
ball  baskets,  string-baskets,  baby-baskets,  and  table-mats. 
Moreover,  in  the  Meath  Home  labor  has  for  its  object  a 
higher  motive  than  that  of  mere  occupation.  The  inmates 
are  charity  workers,  who  interest  themselves  in  many  worthy 


57".    LUKE'S  HOME.  20J 

outside  objects  and  contribute  to  the  relief  of  others  who 
are  not  so  unfortunate  as  themselves.  In  their  spare  time 
and  at  their  own  expense  they  make  clothes  for  desti- 
tute children  living  in  the  town.  Their  sympathy  for  the 
orphans  in  the  Home  for  children  established  by  Lady 
Meath  finds  expression  in  many  loving  acts  of  kindness. 
No  sooner  is  it  known  that  the  little  ones  are  in  need  of 
articles  of  clothing  than  willing  fingers  are  busy  in  the 
Home  of  Comfort  preparing  the  necessary  garments  for 
them.  One  little  boy  forcibly  expressed  his  appreciation 
of  kind  attentions  bestowed  upon  him  by  inmates  of  the 
Home  of  Comfort  by  calling  himself  the  adopted  child  of 
his  Meath  Home  friends;  and  the  Secretary  says:  "  It 
would  probably  be  impossible  to  dislodge  from  his  little 
heart  that  faith  in  womanhood  which,  as  the  boy  grows  into 
the  man,  is  a  shield  that  should  be  proof  against  many  a 
fiery  dart  of  danger  and  distress." 

The  pretty  little  chapel,  with  its  well-trained  choir,  is  a 
noteworthy  feature.  All  concerned  in  the  management 
being  members  of  the  Church  of  England,  the  services  are 
necessarily  those  of  that  Church,  but  no  patient  is  excluded 
from  the  Home  on  account  of  a  difference  of  creed. 

Those  deeply  interested  in  the  work  say:  "  The  Home 
has  been  conducted  thus  far  without  any  great  difficulty 
having  arisen.  Funds  have  not  been  lacking,  and  the  in- 
stitution is,  thanks  to  the  payments  from  patients,  almost 
self-supporting.  If  no  actual  cures  have  been  effected,  the 
inmates  have  experienced  the  comforts  of  home  life.  They 
have  realized  there  is  something  even  the  poor  epileptic  can 
do  to  help  on  the  work  there  is  to  be  done  in  the  world." 

ST.  luke's  home. 

At  Bournemouth,  Carlton  Road,  there  was  established  so 


208  CARE  AND    TREATMENT  OF  EPILEPTICS. 

late  as  1895  a  small  work  on  behalf  of  epileptics.  At 
present  the  Home  provides  accommodation  for  ten  female 
patients  about  the  age  of  sixteen  years,  who  require  nursing. 
The  work  is  under  the  immediate  direction  of  Deaconess 
Elizabeth  Palmer,  a  member  of  the  British  Royal  Nurses'  As- 
sociation, who  is  assisted  by  Nurse  Margaret  Greg,  both  of 
whom  contribute  not  only  their  services,  but  funds  from 
their  private  incomes,  for  the  support  of  the  charity.  The 
usual  charge  for  care  and  nursing  is  about  \2s.  6d.  a  week. 


CHAPTER   IX. 
CONTINENTAL  COUNTRIES. 

IN  tracing  the  origin  and  progress  of  organized  care  of 
epileptics  we  find  the  first  movement  to  have  been 
made  in  Continental  Europe.  In  making  provision  for  this 
afflicted  class  Germany  has  taken  the  lead,  Prussia  especially 
having  made  great  progress ;  and  it  is  much  to  the  credit  of 
the  German  people  that,  down  to  1891,  the  work  had  been 
accomplished  largely  through  Christian  benevolence.  For 
information  respecting  this  branch  of  my  subject,  I  am 
indebted,  among  other  distinguished  authorities,  to  Dr. 
Wildermuth  of  Stuttgart,  Dr.  Kolle  of  Zurich,  Pastor  Siebold 
of  Bielefeld,  and  Dr.  Morel  of  Ghent. 

The  establishment  of  special  institutions  for  the  care  of 
epileptics  has  been  brought  about  during  recent  years,  al- 
though isolated  efforts  in  their  behalf  were  made  during  the 
last  century.  In  1773,  the  Bishop  of  Wiirzburg  established 
in  connection  with  the  Julius  Hospital  a  home  for  the  pro- 
tection of  poverty-stricken  people  afflicted  with  the  so-called 
falling  sickness,  partly  with  the  hope  of  cure  and  partly  for 
the  care  of  those  who  were  incurable.  The  Bishop's  suc- 
cessor continued  this  humane  work  and  cared  for  many 
epileptics  at  his  personal  expense.  In  1845,  a  separate 
building  was  erected  for  them  with  accommodations  for 
forty-eight  free  patients.  A  German  princess,  Pauline 
von    Lippe   Detwold,  about   the  year    18 10  extended  her 

209 


2IO  CARE  AND    TREATMENT  OF  EPILEPTICS. 

philanthropy  to  caring  for  epileptics,  and  recorded  her 
experience  in  favor  of  the  agricultural  system.  A  royal  de- 
cree of  the  Bavarian  Government  in  1819  directed  the 
founding  of  an  asylum  for  this  class  of  sufferers,  but  the 
decree  was  never  carried  out. 

Asylum  care  for  epileptics  may  be  said  to  have  developed 
from  about  the  year  1838,  contemporaneously  with  the  effort 
put  forth  by  that  eminent  philanthropist,  Dr.  Edwin  Seguin, 
of  Paris,  to  educate  the  idiot  class.  Thereafter,  in  the 
numerous  asylums  that  were  provided  for  idiots,  epileptics 
were  generally  received,  more  especially  the  young. 

A  memorable  event  was  the  making  of  provision  on  the 
cottage  and  colony  plan  for  epileptics  at  Laforce  in  France. 
In  1846  John  Bost  returned  to  Laforce  with  the  means 
which  he  had  solicited  in  France  and  England  to  aid  in  the 
establishment  of  a  home  for  dependent  children  in  connec- 
tion with  the  Protestant  church  of  which  he  had  been  re- 
cently chosen  pastor.  His  parishioners,  though  poor  in 
purse,  aided  him  with  their  labor,  and  in  1848  a  cottage  was 
opened  with  accommodations  for  fifty  homeless  girls.  Not 
only  dependent  children  surrounded  by  evil  influences,  but 
children  of  all  conditions  of  bodily  and  mental  weakness, 
were  sent  to  him  for  care,  and  gradually  cottage  homes 
were  provided  for  various  classes  of  sufferers.  Pastor 
Bost's  efforts  to  raise  means  to  carry  on  his  work  were 
courageous  and  persistent.  Liberal  contributions  were 
made  to  aid  his  charities,  but  it  required  considerable  sums 
to  meet  the  expenses  of  his  continually  widening  enterprise, 
and  he  was  constantly  in  straitened  circumstances,  with  his 
sympathies  strained  by  numerous  applications  for  admit- 
tance to  his  homes.  The  pathetic  story  of  the  origin  of 
the  department  for  epileptics  is  thus  told  by  De  Liefde: 
It  happened  one  day  that  a  carriage  stopped  before  the 


CONTINENTAL    COUNTRIES.  211 

door  of  one  of  the  establishments.  Mr.  Bost  walked  out  to 
meet  the  unexpected  visitor.  It  was  a  gentleman  who 
brought  an  epileptic  son.  '  Dear  sir,'  he  said  to  Mr.  Bost, 
'  it  is  only  three  days  since  I  heard  of  the  existence  of  your 
establishment,  and  I  immediately  set  out  with  my  poor 
boy,  for  whom  I  could  find  no  place;  but  he  is  in  the  right 
place  now,  I  trust,  and  you  will  make  me  one  of  the  happiest 
of  fathers.' 

"  The  stranger  produced  letters  of  introduction  and  rec- 
ommendation ;  and  the  joyful  expression  of  his  face  indi- 
cated how  happy  he  felt  at  having  at  length  discovered  an 
establishment  which  could  take  his  child. 

"  '  But,  my  dear  sir,'  Mr.  Bost  replied,  '  I  am  sorry  to 
disappoint  you.  I  cannot  possibly  take  your  son.  He  is 
an  epileptic,  you  say ;  and  I  have  no  establishment  for  such 
patients.' 

1  The  conversation  which  ensued  was  very  touching. 
The  poor  father  took  both  Mr.  Bost's  hands,  and  besought 
him,  with  tears,  to  have  mercy  upon  his  miserable  boy. 
Mr.  Bost's  feelings  for  the  moment  threatened  to  get  the 
better  of  him ;  but  common  sense  resumed  the  reins,  and 
plainly  told  him  that  he  was  about  to  commit  a  folly. 
Father  and  son  both  left,  overwhelmed  with  grief;  but  the 
carriage  had  advanced  but  a  short  distance  when  the  poor 
man  again  jumped  out,  and  in  a  voice  indicative  of  the 
deepest  affliction  again  entreated  Mr.  Bost  for  Heaven's 
sake  to  yield.  Mr.  Bost  once  more  had  strength  to  keep 
inexorable ;  but  no  sooner  had  the  carriage  disappeared 
than  he  burst  into  tears.  The  saying  of  that  poor  father  in 
the  Gospel  occurred  to  his  mind :  '  I  have  brought  him  to 
Thy  disciples,  and  they  could  not  cure  him.'  '  And  I,'  he 
thought,  '  have  not  only  not  tried  to  cure  him,  but  have 
not  even  given  him  any  solace.'  " 


212  CARE  AND    TREATMENT  OF  EPILEPTICS. 

Subsequently  there  came  another  appeal  in  the  form  of 
the  following  letter : 

"  It  is  in  the  name  of  the  Chambre  de  Charite  of  N 

that  I  take  the  liberty  of  inquiring  whether  you  would  con- 
sent to  admit  to  your  establishment  an  unfortunate  boy, 
with  whom  we  do  not  know  what  to  do ;  since  in  him  there 
are  so  many  miseries  and  infirmities  combined  that  not  one 
of  the  public  institutions  to  which  we  have  applied  will 
consent  to  take  charge  of  him.  He  is  a  boy  of  ten.  Owing 
to  disease  he  has  totally  lost  his  hearing.  One  of  his  eyes 
is  also  completely  lost ;  and  he  has  only  a  partial  use  of  the 
other,  since  little  spots  dim  the  sight.  Moreover,  he  is  sub- 
ject to  nervous  epileptic  fits,  and  sometimes  to  maniac 
violence.  His  speech  begins  to  become  more  and  more 
unintelligible,"  etc. 

The  sympathetic  heart  of  Pastor  Bost  could  not  withstand 
such  appeals,  and  he  resolved  to  add  to  his  evangelical  and 
philanthropic  work  the  care  of  epileptics,  which  he  did  by 
opening  a  cottage  for  boys  of  this  class  in  1862,  about  two 
miles  from  the  other  houses.  Suitable  provision  was  also 
made  for  epileptic  girls  in  a  cottage  forming  part  of  the 
original  group  of  buildings.  The  last  house  built  by  him 
was  erected  in  1881.  The  whole  formed  a  group  of  families 
who  lived  as  nearly  as  possible  like  families  in  ordinary 
homes.  Pastor  Bost,  while  favoring  the  use  of  medicine, 
believed  in  the  efficacy  of  outdoor  life  in  the  country  in 
healing  certain  diseases;  in  the  advantages  of  working  in 
the  fields  and  garden,  of  caring  for  animals,  and  of  the 
contemplation  of  the  works  of  nature.  In  one  of  his  re- 
ports he  said : 

"  I  never  visit  the  hospitals  in  our  great  cities  without  a 
feeling  of  distress.  ...  I  will  tell  you  what  is  wanting: 
the  country  air,  the  fragrance  of  the  flowers  and   of  the 


CONTINENTAL    COUNTRIES.  21 3 

earth,  the  morning  dew,  which  is  more  refreshing  than 
many  baths  taken  in  town  or  even  in  rivers.  What  is 
wanting  is  the  beautiful  rays  of  the  sun,  the  harmony  of 
nature,  the  carol  and  warbling  of  birds,  so  adapted  to  cheer 
those  hearts  broken  by  suffering." 

From  these  homes  for  epileptics,  which  form  a  part  of  the 
mixed  colony  founded  by  Pastor  Bost  at  Laforce,  came  the 
first  practical  realization  of  colonizing  this  class  of  sufferers 
and  caring  for  them  in  family  groups. 

In  1855,  Dr.  Reimer  founded  an  asylum  in  Gorlitz, 
Silesia,  exclusively  for  epileptics,  which  was  used  later  for 
mental  diseases  in  general. 

At  Tain,  in  the  Departement  de  la  Drome,  France,  there 
is  the  "  Asile  de  la  Teppe  "  conducted  under  the  auspices 
of  the  Society  of  Saint  Vincent  de  Paul,  where  the  patients 
live  a  family  life  resembling  that  at  Laforce.  The  institu- 
tion possesses  an  extensive  estate  on  the  banks  of  the  Rhone. 
The  origin  of  this  useful  charity  was  somewhat  similar  to 
that  for  the  insane  at  Gheel.  For  two  centuries  epileptics 
had  been  attracted  to  La  Teppe  every  May  and  September, 
at  the  time  of  the  new  moon,  to  receive  from  the  Larnage 
family  the  gift  of  a  supposed  remedy  made  from  Galium 
album,  a  plant  growing  in  that  locality.  This  custom  led 
to  the  founding  in  1857,  by  the  Comte  de  Larnage,  of  the 
Asile  de  la  Teppe  for  sane  epileptics  of  both  sexes.  There 
are  gathered  here  between  two  hundred  and  three  hundred 
patients,  including  children  from  Paris.  The  city  extends 
aid  to  the  Society,  as  do  some  of  the  Departments. 

There  was  opened  in  1862,  in  Wurtemberg,  near  Lake 
Constance  an  institution  for  persons  afflicted  with  epilepsy. 
In  1866  an  asylum,  projected  by  the  Southwest  Confer- 
ence of  Inner  Missions,  was  established  at  Stetten,  Wur- 
temberg, in  connection  with  that  for  idiots.     In   1893  it 


214  CARE  AND    TREATMENT  OF  EPILEPTICS. 

contained  200  epileptics.  Previous  to  1890  it  had  received 
747  patients.  The  care  of  epileptics  in  the  Kingdom  of 
Wurtemberg  is  conducted  altogether  by  private  asylums 
of  a  denominational  character,  the  State  contributing 
largely  towards  their  support. 

In  1867  was  founded  the  celebrated  colony  of  Bethel  near 
Bielefeld,  under  the  auspices  of  the  Provincial  Committee  of 
the  Inner  Mission,  which,  under  Pastor  von  Bodelschwingh, 
has  had  a  marvellous  development. 

Between  1867  and  1890  a  number  of  institutions  for 
epileptics  were  established,  some  for  their  separate  care 
and  others  in  connection  with  idiot  asylums.  The  institu- 
tion founded  at  Konigswartha,  in  the  Kingdom  of  Saxony, 
in  the  year  1877  was  turned  to  another  purpose  in  1882,  its 
place  being  filled  by  the  Hochweitschein  Asylum,  which 
now  contains  upwards  of  600  patients,  including  children. 
Among  others  may  be  mentioned  the  asylum  "Kreuzhilfe," 
which  was  opened  in  1877;  the  asylum  for  epileptics  in 
Rotenburg,  in  the  province  of  Hanover,  established  in  1880, 
which  comprises  seven  houses  with  accommodations  for 
nearly  300  epileptics;  the  asylum  "  Mariahilf,"  at  Tilbeck, 
in  Westphalia,  established  for  children  in  1881,  under 
Roman  Catholic  direction,  and  now  containing  about  200 
women  and  children;  the  asylum  "  Karlshof  "  at  Rasten- 
burg  in  East  Prussia,  founded  in  1882,  for  epileptics  of 
both  sexes.  At  Stettin  in  Pomerania  the  epileptic  asylum 
"  Tabor  "  was  established  in  1882.  Something  more  than 
two  years  ago  it  contained  nearly  250  patients.  There  is 
an  asylum  at  Rath  near  Dusseldorf,  which  was  opened  in 
1883.  It  is  conducted  under  Roman  Catholic  auspices, 
and  contains  upwards  of  100  women.  The  home  of  the 
Alexianer  Brothers  at  Aix-la-Chapelle,  containing  200 
patients,   was  opened    the   same   year,  and    the  work   has 


CONTINENTAL    COUNTRIES.  21  5 

been  extended  by  creating  a  branch  near  the  city.  A 
home  established  by  the  Franciscans  was  opened  at  Olpe, 
Westphalia,  in  1884,  for  epileptic  children.  St.  Valentine's 
Home  in  Kiedrich,  Hesse-Nassau,  was  opened  in  1886  for 
female  epileptics.  The  same  year  there  was  established  at 
Potsdam,  in  the  province  of  Brandenburg,  an  asylum  for 
those  suffering  from  epilepsy,  which  now  has  accommoda- 
tions for  about  275  patients.  In  1893,  it  came  under  the 
charge  of  the  province. 

Among  the  institutions  established  in  Continental  Europe 
during  the  past  fifteen  years  deserving  special  attention 
as  illustrating  advanced  ideas  of  the  German  methods  of 
caring  for  epileptics,  are  the  Swiss  Asylum  at  Zurich,  the 
city  of  Berlin  asylum,  "  Wuhlgarten,"  and  the  Uchtspringe 
government  asylum  in  Saxony.  The  Swiss  Asylum,  in  the 
projection  of  which  there  was  a  practical  utilization  of  a 
vast  amount  of  previously  acquired  experience,  was  founded 
in  1886;  "  Wuhlgarten,"  elsewhere  described,  was  opened 
in  1893;  and  the  large  asylum  of  Uchtspringe,  near  Nein- 
stedt,  in  1894. 

Though  Germany  is  in  advance  of  other  countries  in 
making  provision  for  epileptics,  even  there  the  accommo- 
dations for  this  class  are  far  from  being  sufficient.  Most  of 
the  work  in  this  direction  has  been  undertaken  by  private 
organizations  directed  by  religious  societies,  the  Government 
in  some  instances  lending  liberal  aid.  Only  in  the  kingdoms 
of  Prussia  and  Saxony  has  the  Government  taken  in  hand 
the  establishing  of  institutions  for  epileptics.  In  Saxony 
State  care  has  existed  for  a  considerable  time.  Systematic 
government  care  was  guaranteed  to  epileptics  in  Prussia 
by  a  law  passed  in  1891.  This  important  measure  made  it 
obligatory  upon  the  Poor  Law  authorities  to  provide,  after 
April  1,  1893,  asylum  care  for  such  of  the  dependent  insane, 


2l6  CARE  AND    TREATMENT  OF  EPILEPTICS. 

epileptics,  the  deaf  and  dumb,  and  the  blind,  as  required  it. 
In  carrying  out  this  law,  so  far  as  it  affects  epileptics,  the 
existing  asylums  of  Prussia  for  epileptics  and  idiots  have 
been  brought  into  requisition  and  new  institutions  have 
been  built,  are  in  process  of  construction,  or  are  projected. 
Besides  institutions  in  Germany  and  France,  the  follow- 
ing may  be  mentioned :  In  Italy  there  is  an  asylum  at  Ber- 
gamo. There  is  a  small  one  in  Russia,  near  St.  Peters- 
burg, which  is  conducted  under  evangelical  auspices.  One 
of  the  several  departments  of  the  institution  for  feeble- 
minded at  Copenhagen,  in  Denmark,  is  in  the  outskirts  of 
the  city  and  is  devoted  to  epileptics.  A  small  work  was 
begun  at  Christiania,  in  Norway,  in  1883,  also  at  Wilhelmsro, 
in  Sweden,  in  1892.  At  Haarlem,  in  Holland,  a  work  for 
epileptics  is  carried  on  in  what  is  called  the  Christian  Home, 
under  the  direction  of  deaconesses.  Seventy  women  are 
provided  for  in  two  buildings  called  Sarepta  and  Bethesda, 
the  garden  and  grounds  of  which  are  enclosed  by  a  wall. 
Under  the  same  board  of  management  are  three  houses  in 
the  country  containing  about  seventy-five  male  patients, 
who  are  cared  for  by  deacons.  The  institution  receives  but 
few  except  private  patients.  These  are  divided  into  four 
classes,  paying  from  $120  to  $500  yearly.  Children  are  ad- 
mitted at  lower  rates.  The  receipts  of  the  Home  fall  con- 
siderably short  of  its  expenditures.  The  deficits  are  met 
by  voluntary  contributions. 

WUHLGARTEN. 

An  important  step  affecting  the  welfare  of  epileptics  has 
been  taken  by  the  establishment  of  the  Wuhlgarten  Asylum 
at  Biesdorf,  near  Berlin.  Previous  to  the  creation  of  this 
institution  it  had  become  manifest  that  further  extension  of 
facilities  for  the  care  of  the  insane  of  Berlin  was  necessary. 


WUHLGARTEN.  2\"J 

Instead  of  building  a  new  asylum  for  them,  it  was  decided 
to  develop  a  plan  for  the  separate  treatment  of  epilep- 
tics, large  numbers  of  whom,  designated  by  the  statute  as 
incompetent  persons,  were  confined  in  the  asylum  for  the 
insane  at  Dalldorf.  By  removing  these  the  desired  accom- 
modation for  the  insane  would  be  provided.  The  question 
of  separating  the  care  of  epileptics  from  that  of  the  insane 
had  been  long  discussed  in  various  societies  of  alienists,  and 
the  desire  to  put  in  practical  operation  this  principle  in  Ber- 
lin had  its  influence  in  establishing  the  Wuhlgarten  Asylum. 
The  erection  of  buildings  was  begun  in  1890,  and  the  insti- 
tution was  opened  for  patients  in  November,  1893,  at  which 
time,  or  soon  thereafter,  the  epileptics  from  the  insane 
asylum  at  Dalldorf  were  admitted.  Wuhlgarten  is  sup- 
ported by  the  city,  and  its  affairs  are  directed  by  the  same 
Board  that  controls  and  directs  the  city  institutions  for  the 
insane.  The  Board  reports  to  the  city  magistrates.  The 
asylum  is  in  the  immediate  charge  of  a  medical  director, 
Dr.  Heboid,  who  is  also  Superintendent. 

The  institution  was  first  planned  for  500  patients,  with 
the  possibility  of  increasing  its  accommodations  to  1000. 
It  was  finally  constructed  to  accommodate  1100;  that  is  to 
say,  500  each  of  men  and  women,  and  50  each  of  boys  and 
girls.  It  was  thought  that  there  would  be  about  an  equal 
number  of  the  sexes,  but  there  proved  to  be  a  prepon- 
derance of  males.  At  the  date  of  February  28,  1898,  there 
were  913  patients  under  care;  524  of  these  were  men,  54 
were  boys,  301  were  women,  and  34  were  girls.  The  prop- 
erty of  the  asylum  includes  only  about  222  acres,  105  of 
which  are  devoted  to  agricultural  purposes,  28  to  meadow, 
and  the  remainder  is  occupied  with  buildings,  or  taken  up 
with  ornamental  and  recreation  grounds  and  a  small  lake. 

Notwithstanding  Wuhlgarten  is  built  somewhat  after  the 


218  CARE  AND    TREATMENT  OF  EPILEPTICS. 

cottage  plan,  about  all  its  departments  there  is  a  seeming 
lack  of  outdoor  space  and  freedom,  which  are  desirable  in  an 
institution  of  this  kind.  The  administration  building  con- 
tains the  office,  consultation-room,  library,  pharmacy,  several 
rooms  for  the  assistant  physicians,  and  halls  for  entertain- 
ments. The  chapel  is  situated  opposite  the  administration 
building,  and  in  the  rear  of  it  is  the  mortuary.  The  house  of 
the  Director  stands  at  one  side  of  the  chapel,  and  that  oc- 
cupied by  other  officers  of  the  institution  on  the  opposite 
side.  Back  of  the  administration  building  is  the  domestic 
department,  containing  the  kitchen,  laundry,  storeroom, 
the  offices  for  the  superintendents  of  industrial  work  and 
farming,  and  the  servants'  quarters. 

In  the  rear  of  the  domestic  department  is  the  power- 
house, in  which  are  ten  boilers  for  generating  steam,  two 
dynamos,  and  a  storage  battery  for  the  electric-light  sys- 
tem. Water  is  supplied  from  the  city  water  works.  There 
is  a  steam  force-pump  for  protection  against  fire.  The 
buildings  are  warmed  by  a  central  heating  plant. 

Near  the  entrance  to  the  grounds,  at  the  left,  is  the 
department  for  children.  Here  reside  the  superintendent 
of  education  and  two  male  and  two  female  teachers.  The 
ground  floor  is  divided  into  schoolrooms.  In  the  upper 
story  are  the  bedrooms,  and  a  large  dining-  and  assembly- 
room.  The  sleeping-rooms  for  the  boys  are  in  a  separate 
wing  from  those  for  the  girls.  There  are  also  in  this  build- 
ing a  large  gymnasium,  a  medical  consulting  room,  and 
workrooms  for  children. 

In  planning  the  buildings  for  adult  patients  the  aim  was 
kept  in  view  of  permitting  as  much  liberty  of  action  to  those 
occupying  them  as  practicable,  but  it  was  thought  that  about 
1 20  out  of  500  would  require  restricted  treatment.  For 
these  there  were  erected,  on  either  side  of  the  administra- 


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WUHL  GA  R  TEN.  2 1 9 

tion  building,  two  separate  houses — one  for  each  sex — 
modelled  after  the  departments  of  insane  asylums  caring 
for  a  similar  class  of  patients.  The  most  serious  cases, 
including  the  bedridden,  restless,  maniacal,  and  dangerous, 
are  here  provided  for.  In  each  of  these  houses  are  eight 
cells  or  rooms  which  are  locked  when  occupied.  There  are 
also  reception-rooms  where  new  arrivals  are  kept  under  ob- 
servation until  the  condition  of  each  has  been  fully  deter- 
mined. Dr.  Heboid  has  given  the  result  of  his  experience 
with  these  buildings  in  the  following  language : 

We  have  found  it  to  be  a  great  disadvantage  that  all  the 
dangerous  and  unmanageable  patients  are  thus  brought 
together  under  one  roof.  Among  epileptics  there  is  a  large 
number  of  degenerates — of  those  whose  fate  is  sealed  before 
their  birth — given  to  quarrelling  and  fighting,  to  forming 
plots  and  to  vicious  practices,  such  as  pederasty  and  mutual 
onanism.  These  patients  are  entirely  lawless  and  criminal. 
As  long  as  they  live  indoors  they  are  to  a  certain  extent 
kept  separated  in  four  or  five  different  divisions,  but  in 
the  yard  they  meet  without  restriction.  A  certain  relief 
is  afforded  by  our  ability  to  transfer  extremely  vicious 
insane  epileptics  who  have  withstood  all  treatment  to  one 
of  the  two  insane  asylums  which  have  a  separate  division 
for  each  sex." 

The  great  majority  of  the  patients  live  in  so-called  cot- 
tages, of  which  there  are  twelve  for  males  and  a  like  number 
for  females.  These  differ  in  no  way  from  ordinary  dwelling- 
houses  and  are  variously  planned  to  accommodate  twenty, 
thirty,  or  forty  patients.  On  the  lower  floor  are  the  sit- 
ting-rooms and  on  the  upper  the  bedrooms.  In  some  of  the 
cottages  there  are  also  bedrooms  downstairs.  Three  of  these 
buildings  are  arranged  as  infirmaries — two  for  men  and  one 
for  women.      They  are  designed  to  meet  the  emergency  of 


220  CARE  AND    TREATMENT  OF  EPILEPTICS. 

short  periods  of  illness  only,  and  are  not  adapted  to  the 
care  of  bedridden  patients,  as  they  lack  bathing  facilities. 
Baths  are  taken  in  the  bath-house,  which  stands  in  the 
centre  of  the  space  occupied  by  the  cottages.  Three  rooms 
in  the  infirmaries  are  arranged  for  patients  suffering  from 
unforeseen  temporary  attacks  of  excitement. 

In  the  spring  of  1898  the  men  were  employed  as  fol- 
lows: 107  about  the  gardens,  fields,  grounds,  and  stables; 
69  as  house  laborers ;  16  in  clerical  work ;  2  as  house-fathers ; 
one  as  a  maker  of  seltzer  water ;  8  as  laborers ;  1 1  at  shoe- 
making;  10  at  tailoring;  3  at  bookbinding;  one  at  uphol- 
stering ;  15  at  hair-picking;  10  at  carpentering;  4  at 
basket-making;  7  at  brush-making;  33  as  straw-plaiters. 
The  women  were  engaged  as  follows:  20  at  housework; 
67  at  sewing;  64  at  mattress-making,  mending,  and  knit- 
ting; and  20  in  the  kitchen. 

In  the  way  of  entertainment  much  attention  is  given  to 
music.  There  are  occasional  stereopticon  exhibitions,  the- 
atrical performances,  frequent  dances,  bowling,  and  other 
amusements. 

The  education  is  on  the  same  lines  as  that  of  the  common 
schools  of  Prussia. 

The  charge  for  private  patients  admitted  from  the  city  of 
Berlin,  provided  there  is  room  for  such,  is  two  marks  a  day. 

The  medical  service  of  the  asylum  is  directed  by  Dr. 
Heboid  and  his  five  assistants.  The  former  gives  special 
attention  to  the  building  for  the  insane  and  the  vicious 
males.  Two  of  the  assistants  are  assigned  to  the  cottages 
for  men  and  one  to  those  for  women.  The  first  assistant 
oversees  the  children's  home  and  the  second  that  for  insane 
and  vicious  females.  Daily  rounds  are  made  by  the  medi- 
cal director,  who  visits  all  the  different  departments,  and  a 
daily  meeting  is  held  of  all  the  physicians  for  consultation 


WUHLGAR  TEN.  22 1 

and  for  the  purpose  of  attaining  unity  in  methods  of  treat- 
ment.    Of  the  system  of  treatment  Dr.  Heboid  says : 

"  Since  our  belief,  founded  upon  clinical  experience,  that 
epilepsy  is  a  hereditary  and  permanent  disease,  is  verified 
by  anatomic  investigation,  we  must  not  expect  too  much 
from  treatment.  If  we  overcome  the  convulsive  seizures 
we  have  achieved  a  result  worthy  of  effort,  but  it  will  always 
be  self-deception  to  consider  this  a  cure.  The  fundamental 
structure  remains  the  same,  and  there  is  always  danger  of  a 
recurrence  of  attacks.  Altered  and  diseased  tissues  cannot 
be  made  normal.  We  must  strive  for  an  improvement  of 
the  longest  possible  duration.  Of  this  improvement  the 
cessation  of  attacks,  if  the  mental  state  continues  clear,  is 
an  outward  sign.  To  effect  this  the  patient  must  give  his 
co-operation  by  thoroughly  mastering  the  rules  of  treatment 
prescribed  by  the  institution. 

"  Our  methods  do  not  differ  from  those  ordinarily  em- 
ployed. We  lay  the  greatest  stress  upon  the  management 
of  the  daily  life,  all  excesses  being  rigidly  avoided.  Out- 
of-door  work  and  farming  are  of  great  value.  Mechanics 
are  given  an  opportunity  for  employment  in  pleasant,  roomy 
workshops.  It  is  necessary  to  consider  the  inclinations  of 
the  patients. 

"  In  regard  to  the  food,  I  would  mention  that  it  is  not 
too  heavy.  We  try  to  provide  meat  and  vegetables  in 
proper  relative  quantity  and  in  desirable  variety.  We  be- 
lieve experiments  with  any  particular  form  of  diet  with  the 
aim  of  proving  its  special  therapeutic  value  to  be  disadvan- 
tageous, and  not  even  of  theoretic  interest.  Moderation  in 
diet  is,  however,  of  great  importance,  especially  in  regard 
to  alcoholic  beverages.  We  have  entirely  discontinued  the 
use  of  beer,  and  are  well  satisfied  with  the  beneficial  effects 
of  entire  abstinence  from  alcohol. 


222  CARE  AND    TREATMENT  OF  EPILEPTICS. 

"  Our  medical  treatment  is  the  usual  one.  The  bromides 
are  most  extensively  employed  ;  other  drugs  are  occasionally 
tried,  but  we  always  return  to  the  old  standbys.  We  are 
unable  to  say  much  in  praise  of  the  Flechsig  treatment.  For 
the  status  epilepticus  chloral  hydrate  alone  is  of  much  value. 
States  of  excitement  and  apprehension  demand  sedatives. 
Besides  the  narcotics  we  make  use  of  hydrotherapy  in  the 
form  of  prolonged  tepid  baths,  wet  packs,  and  cold  ablu- 
tions." 

SWITZERLAND. 

In  the  Republic  of  Switzerland  there  are  three  asylums 
for  epileptics;  one  at  Zurich,  one  at  Rolle,  and  one  at 
Schloss  Tschugg.  All  of  these  institutions  are  governed 
by  private  benevolent  organizations,  and  are  under  the 
supervision  of  the  Government.  They  are  supported  by 
voluntary  contributions,  by  aid  received  from  the  cantons, 
and  by  payments  from  patients  for  board. 

About  seventy-five  per  cent,  of  the  inmates  belong  to  the 
dependent  class,  and  for  these  the  home  parishes  pay  three 
hundred  francs  per  capita  annually,  which  is  about  one  half 
the  cost  of  care.  Private  patients  pay,  according  to  the  ac- 
commodations afforded,  from  four  hundred  to  nine  hundred 
francs;  and  in  a  very  few  cases  as  high  as  three  thousand 
francs  have  been  received. 

The  asylums  at  Rolle  and  Schloss  Tschugg  have  each 
two  buildings.  At  the  close  of  the  year  1895  the  former 
had  2  male  and  16  female  patients,  and  the  latter  had  34 
male  and  38  female  patients.  At  Zurich  there  are  three 
buildings, — one  having  a  capacity  for  55  children,  another 
for  75  women,  and  a  third  for  20  men.  In  addition,  a  new 
building  will  soon  be  ready  to  accommodate  75  male  adults, 
and  the  erection  of  a  hospital  is  in  contemplation.  It  is  in- 
tended that  the  asylum  shall  eventually  provide  for  from  300 


S  WI TZERLA  ND.  223 

to  400  patients.  Insane  epileptics  are  not  received,  and 
such  as  become  permanently  deranged  are  transferred  to 
insane  asylums. 

The  asylum  at  Zurich  was  founded  in  1886  by  a  society 
whose  members  belonged  to  the  different  cantons  of  the 
country  and  by  a  committee  of  men  and  women  of  Zurich. 
The  management  is  vested  in  the  Director,  the  physician 
in  charge,  and  the  pastor  of  the  institution.  During  its 
existence  about  one  thousand  persons  have  applied  for  ad- 
mission, but  not  more  than  half  of  the  applicants  could  be 
received.  Dr.  Kolle  has  been  Director  of  the  Swiss  insti- 
tution from  its  foundation,  and  to  his  experience  of  more 
than  thirty-five  years  in  the  care  of  epileptics  is  due  much 
of  the  success  that  has  attended  the  work. 

The  asylum  owns  about  twenty-five  acres  of  land.  Two 
and  one  half  acres  are  set  apart  for  gardens  and  about  two 
acres  for  vineyards. 

The  men  are  employed  on  the  farm,  in  the  gardens  and 
vineyards,  at  the  carpenter's  bench,  at  tailoring,  and  in  the 
binding  of  books.  They  also  make  carpets  and  shoes  and 
do  basket-work.  The  adult  female  patients  do  various 
kinds  of  women's  handiwork — embroidery,  general  sewing, 
and  the  regular  work  of  the  household.  Employment  is 
provided  for  each  one,  for  the  epileptic  asylum  at  Zurich 
has  no  place  for  the  idle. 

The  boys  are  classified  in  two  divisions,  as  are  also  the 
girls.  The  women  form  eight  divisions  and  the  men  two. 
In  addition  to  these  regular  patients  there  are  also  in  each 
of  the  three  houses  a  few  patients  of  the  first  class,  who 
have  special  accommodations  and  attendance. 

The  children  receive  instruction  from  two  male  and  two 
female  teachers.  There  are  two  educational  departments — 
the  school  proper,  for  normally  intelligent  pupils  and  the 


224  CARE  AND    TREATMENT  OF  EPILEPTICS. 

moderately  feeble-minded  epileptics;  and  the  preparatory- 
school,  for  the  decidedly  feeble-minded  epileptics.  The 
course  of  study  is  somewhat  as  follows: 

The  pupils  of  the  preparatory  school  are  instructed  in 
Bible  history,  reading  and  writing,  arithmetic,  drawing 
according  to  Froebel,  gymnastics,  and  manual  training, 
including  sewing  and  weaving. 

In  teaching  Bible  history  the  simplest  tales  of  the  Old 
and  New  Testaments  are  illustrated  by  means  of  pictures, 
and  the  children  commit  to  memory  psalms  and  verses  easy 
to  learn.  The  lessons  in  reading  and  writing  are  very 
simple.  There  is  special  speech  practice  for  stammerers. 
In  arithmetic  there  are  exercises  in  addition  and  subtraction 
with  numbers  from  one  to  five,  in  which  many  means  of 
illustration  are  employed.  The  gymnastics  include  ordinary 
walking,  marching,  and  exercises  for  arms,  legs,  shoulders, 
and  head. 

In  the  lower  department  of  the  school  proper  there  are 
taught  Bible  history,  language,  arithmetic,  writing,  and 
drawing  according  to  Froebel's  system.  In  language  study 
there  are  three  divisions.  The  pupils  read  from  the  school 
reader,  study  nouns,  verbs,  and  adjectives,  and  practise 
easy  composition  in  connection  with  illustrative  teaching. 
They  are  also  given  verbal  and  written  exercises.  In  arith- 
metic there  are  also  three  divisions.  In  object  teaching 
there  are  discussions  of  familiar  objects,  such  as  flowers, 
fruits,  household  articles,  and  animals  shown  in  pictures. 
Writing  lessons  include  capitals  as  well  as  small  letters  and 
German  and  Latin  script. 

For  the  higher  classes,  instruction  in  the  foregoing 
branches  is  continued,  and  the  pupils  also  enter  upon 
the  study  of  natural  history  and  geography.  In  the 
Bible    classes   the   memorizing    of    psalms   and   verses    is 


SWITZERLAND.  22  5 

continued,  and  the  subjects  under  consideration  are  the  life 
of  Jesus,  Baptism,  Christian  dogma,  Our  Father,  the  Ten 
Commandments,  and  the  Sacrament.  In  language  there 
are  two  divisions.  The  exercises  in  Class  A  include  read- 
ing, reciting  stories,  committing  to  memory  a  poem  occa- 
sionally, writing  a  composition  once  a  week,  and  parsing. 
There  are  also  frequent  dictation  lessons. 

The  pupils  of  Class  B  read  from  the  school  reader,  study 
pronouns,  prepositions,  past,  present,  and  future  tenses,  and 
write  compositions.  Simple  selections  are  read  and  dis- 
cussed and  made  subjects  of  composition,  and  dictation 
exercises  are  given. 

In  arithmetic,  the  members  of  Class  A  review  previous 
work  and  study  the  subject  of  interest ;  Class  B  has  before 
it  the  application  of  general  principles,  interest,  etc.,  and 
Class  C,  addition,  subtraction,  multiplication,  and  division. 

In  summer  the  pupils  of  the  natural  history  class  study 
different  plants;  and  in  winter  birds  and  insects. 

In  geography  there  are  three  divisions;  in  history  local 
wars  are  made  subjects  of  study ;  linear  drawing  is  taught ; 
also  the  singing  of  two-  and  three-part  songs  and  chorals. 

All  the  adult  female  patients  who  are  able  to  compre- 
hend the  subject  are  admitted  to  the  class  in  Bible  history. 

In  order  to  avoid  over-exertion  on  the  part  of  pupils, 
Dr.  Kolle  recommends  that  the  daily  lessons  should  not 
continue  longer  than  from  three  to  five  hours,  with  recesses. 
On  the  other  hand,  he  says  that  long  vacations  are  no  less  to 
be  avoided ;  and  that  the  patients  should  never  be  permit- 
ted to  be  entirely  idle  even  in  recreation  hours,  as  idleness 
leads  to  brooding.  Respecting  the  benefits  of  intellectual 
training  to  the  epileptic,  Dr.  Kolle  says:  "  We  believe  it  to 
be  entirely  a  mistake  to  consider  lessons  as  equivalent  to 
excitement;  on  the  contrary,  if  they  are  carried  on  in  an 


226  CARE  AND    TREATMENT  OF  EPILEPTICS. 

interesting,  animated  way,  we  must  welcome  them  as  a  help 
to  the  epileptic,  as  we  do  all  influences  which  tend  to  lift 
him  out  of  his  brooding  moods,  his  mental  dulness,  and 
apathy.  I  know  many  an  epileptic  pupil  who,  thanks  to 
good  teaching,  enjoys  a  simple  but  rich  spiritual  life.  In- 
struction in  singing,  as  in  drawing,  must  be  considered  as 
especially  stimulating,  and  therefore  as  valuable.  In  the 
latter  branch  the  writer  gives  preference  to  linear  drawing  in 
colors,  which  pleases  and  interests  the  children.  In  this 
the  pupils,  who  often  remain  but  a  comparatively  short  time 
in  the  institution,  show  satisfactory  progress."  Epileptic 
children  are  not  allowed  to  practise  upon  the  piano  or  the 
violin,  as  the  peculiar  exercise  involved  in  so  doing  tends 
to  bring  on  an  attack. 

At  the  Zurich  Asylum  three  principal  meals  are  served — 
at  7  A.M.,  12  M.,  and  J  P.M.  At  mid-forenoon  a  lunch 
consisting  of  bread  and  fruit  or  milk  is  allowed,  and  at 
mid-afternoon  bread  with  milk  or  weak  coffee  is  given. 
Milk  and  eggs  are  considered  desirable  nourishment.  The 
use  of  alcohol  is  not  permitted. 

As  to  the  efficacy  of  the  treatment,  Dr.  Kolle  says  that 
it  is  difficult  to  give  figures,  though  the  general  results  are 
positive.  He  estimates  that  about  ten  per  cent,  are  cured 
and  forty  per  cent,  improved. 

BETHEL   COLONY   NEAR   BIELEFELD. 

Divine  love  glowing  in  the  hearts  of  a  devoted  band  of 
men  and  women  working  in  the  shadows  of  the  Westphalian 
mountains  has  so  illumined  the  world  as  to  attract  philan- 
thropists from  all  civilized  countries  to  that  hallowed  spot, 
to  study  a  unique  phase  of  charity.  The  colony  at  Biele- 
feld has  been  so  many  times  particularly  described  by  vari- 
ous writers  that  it  seems  unnecessary  to  add  little  else  than 


BETHEL    COLONY.  2.2."] 

information  respecting  the  present  status  of  the  work, 
obtained  mainly  from  official  sources  by  recent  correspon- 
dence. 

The  institution,  established  by  the  Provincial  Committee 
of  the  Inner  Mission  in  Rhineland  and  Westphalia,  is  sit- 
uated on  the  outskirts  of  Bielefeld,  a  city  in  the  province 
of  Westphalia,  Germany,  having  about  fifty  thousand  in- 
habitants. On  the  1st  of  July,  1898,  the  settlement  con- 
tained, with  its  officers,  physicians,  nurses,  and  employees, 
about  3500  persons.  The  colony,  lying  mainly  in  a  pleasant 
valley,  embraces  a  great  variety  of  residences  surrounded  by 
gardens  and  hedges,  shops  for  artisans  of  various  trades, 
places  of  worship,  meadow-lands,  and  groves.  On  an  emi- 
nence overlooking  the  colony  there  looms  up  in  striking 
contrast  the  ancient  castle  of  Sparrenburg,  whose  massive 
ruined  walls  speak  of  a  more  selfish  age,  when  the  world 
was  ruled  by  might,  and  might  made  right. 

The  Bethel  Colony  is  an  evangelical,  charitable  institution, 
differing  in  its  management  and  development  from  any  other 
establishment.  The  work  was  begun  upon  a  small  farm  in 
1867.  The  simple  exercises  connected  with  the  opening  of 
the  farmhouse  included  the  offering  of  prayer  by  the  vener- 
able pastor,  who  knelt  in  the  parlor  with  four  patients  and 
asked  God's  blessing  upon  the  undertaking.  In  1872, 
Friedrich  von  Bodelschwingh,  a  Protestant  clergyman,  ig- 
noring the  prestige  of  an  aristocratic  title,  gave  up  court 
life  and  the  companionship  of  the  German  nobility,  to  de- 
vote his  life  to  the  building  up  of  this  hospital  and  home  for 
neglected  epileptics.  When  he  assumed  his  duties  there 
were  twenty-four  male  patients  at  Ebenezer,  as  the  farm- 
house was  called  where  the  work  was  formally  begun.  A 
large  building,  planned  to  accommodate  two  hundred  pa- 
tients,  was  in   process   of   erection.     This  was  afterwards 


228  CARE  AND    TREATMENT  OF  EPILEPTICS. 

completed,  although  disapproved  of  by  Pastor  von  Bodel- 
schwingh  as  not  in  accord  with  a  true  colony  plan.  He 
wisely  desired  that  the  patients  should  be  distributed  in 
small  family  groups,  and  this  policy  was  adopted  in  the 
future  development  of  the  institution.  The  large  building 
was  called  Bethel,  a  name  gradually  applied  to  the  whole 
colony. 

To  the  small  original  farm  have  been  added  from  time  to 
time  tracts  of  land  varying  in  size  until  the  estate  now  com- 
prises about  three  thousand  acres.  As  opportunity  offered, 
other  benevolent  work  was  undertaken,  which  has  proved 
far-reaching  and  beneficent  in  its  results.  This  includes, 
among  other  enterprises,  saving  efforts  in  behalf  of  children, 
not  only  such  as  are  epileptic,  but  the  homeless  and  the  en- 
feebled and  the  crippled,  the  establishment  of  the  Work- 
man's Home,  and  the  branch  labor  colonies  of  Wilhelms- 
dorf  and  Freistatt.  The  most  important  work  of  this  broad 
charity,  however,  is  now,  as  it  was  at  the  outset,  the  care 
of  epileptics,  who  numbered  1516,  including  children,  on  the 
1st  of  July,  1898. 

Of  the  169 1  patients  cared  for  during  the  year  1897, 
there  were  from  Westphalia  390,  from  the  Rhine  Province 
389,  from  Hanover  257,  from  Schleswig-Holstein  179,  from 
the  government  district  Cassel  100,  from  the  government  dis- 
trict Wiesbaden  78,  from  the  Grand  Duchy  of  Hesse  65.  The 
remainder  were  from  other  provinces,  states,  and  countries, 
including  eight  from  America,  four  from  England,  three 
from  the  Netherlands,  two  from  Sweden  and  Norway,  two 
from  Denmark,  two  from  Switzerland,  six  from  Russia,  and 
four  from  Africa.  The  creed  of  most  of  the  patients  is 
evangelical,  less  than  three  per  cent,  being  Roman  Catho- 
lics, Israelites,  and  of  other  faiths. 

The  patients  at  the  Bethel  Colony  on  the  1st  of  January, 


PASTOR    VON    BODELSCHWINGH    WITH    THEOLOGICAL   CANDIDATES. 


BETHEL    COLONY.  229 

1897,  numbered  1441.  There  were  663  men,  550  women, 
and  228  children  under  fifteen  years  of  age,  of  whom  123 
were  boys  and  105  were  girls.  During  the  year  250  patients 
were  received  and  199  were  discharged. 

The  records  showed  that  166,663  fits  occurred  during  the 
year,  84,865  of  which  were  reported  as  serious  attacks, 
8580  as  light,  and  73,218  as  quite  short  attacks  of  epileptic 
dizziness.  A  great  number  of  fits  are  not  noted,  as  they 
occur  at  night  and  are  unobserved ;  and  throughout  the  day 
and  night  light  attacks,  and  attacks  of  dizziness  while  at 
labor,  are  regarded  as  not  severe  enough  to  be  noted.  Of 
persons  thus  afflicted,  however,  there  are  not  a  great  number, 
as  experience  has  proved  that  for  the  most  part  only  those 
very  sick  and  who  have  for  years  suffered  from  epilepsy  are 
given  over  to  the  asylum.  All  the  efforts  made  by  the  colony 
officials  to  have  epileptics  brought  under  early  treatment 
have  proved  futile  through  lack  of  judgment  in  parents  or 
guardians,  who  see  in  the  asylum  only  an  ultimate  refuge 
and  place  of  last  resort ;  and  precious  time  is  lost  in  vain 
attempts  to  cure  before  sending  the  sick  one  out  of  the 
family.  The  managers  appeal  to  all  interested  in  the  welfare 
of  epileptics  to  enlighten  the  public  as  to  the  necessity  of 
early  commitment  to  asylum  care. 

The  entire  number  of  patients  received  in  the  colony 
since  its  establishment  down  to  January  1,  1898,  was  5028. 
Of  these,  388,  or  y.y  per  cent.,  were  discharged  as  cured; 
1099,  or  21.2  per  cent.,  as  improved;  1058,  or  21  per  cent., 
as  not  cured;  and  991,  or  19.7  per  cent.,  died.  It  is  said 
that  about  61  per  cent,  of  those  who  were  discharged  as 
cured  were  under  eighteen  years  of  age.  As  but  a  little 
over  one  third  of  the  entire  number  of  patients  were  under 
eighteen  years  of  age,  the  figures  show  how  small  a  propor- 
tion above  that  age  were  cured.     A  patient  is  not  regarded 


23O  CARE  AND  TREATMENT  OF  EPILEPTICS. 

as  permanently  cured  until  the  lapse  of  four  years  without 
an  attack.  If  two  years  pass  without  a  seizure  he  is  dis- 
charged from  the  institution,  but  is  not  regarded  as  cured  if 
he  has  an  attack  during  the  two  years  following  his  dis- 
charge. 

Dr.  Warnek  designates  as  temporarily  cured  all  those  who 
for  a  year's  time  have  not  had  an  attack.  He  says:  "  We 
can  be  satisfied  with  this  result  when  we  take  into  account 
the  severity  of  the  suffering  and  the  long  continuance  of  the 
illness  of  the  patients  before  entering  the  institution.  With- 
out our  help  these  would  have  fallen  into  greater  suffering. 
Our  medical  treatment  preserves  from  falling ;  that  is  to  say, 
we  keep  the  patient  from  swiftly  descending  into  weak- 
mindedness  and  idiocy  and  retain  him  for  years  in  a  state  in 
which  he  can  contribute  something  to  the  common  weal." 

Respecting  the  mental  condition  of  the  patients,  it  is 
officially  stated  that  of  the  5028  received  into  the  asylum 
only  47  have  been  turned  over  to  insane  asylums ;  and  on 
the  1st  of  January,  1898,  there  were  but  13  male  and  12 
female  patients  in  the  closed  departments  for  cases  suffering 
from  temporary  mental  derangement.  At  that  time  25  per 
cent,  of  the  patients  were  without  any  perceptible  mind 
disease;  33  per  cent,  had  only  slight  defects  of  mind;  17 
per  cent,  were  classed  as  mentally  disturbed;  and  25  per 
cent,  as  imbecile. 

In  regard  to  the  length  of  life  of  epileptics,  Dr.  Warnek 
says :  "  We  find  confirmed  the  old  experience  that  epileptics 
in  general  do  not  attain  an  old  age  and  that  a  large  major- 
ity perish,  not  from  ordinary  sickness,  but  from  the  conse- 
quences of  epilepsy."  Of  68  patients  who  died  in  1895,  five 
were  under  ten  years  of  age,  13  under  twenty  years,  18 
under  thirty  years,  15  under  forty  years,  13  under  fifty 
years,  one  under  sixty  years,  and  three  under  seventy  years. 


BETHEL    COLONY.  23 1 

As  to  hereditary  influences,  the  experience  at  Bethel 
proves  that  they  are  the  most  potent  factors  in  the  disease 
of  epilepsy.  The  decrease  of  tuberculosis  in  the  institution 
is  attributed  to  the  practice  of  isolating  tuberculosis  pa- 
tients and  thereby  lessening  the  danger  of  communicating 
the  disease  to  others. 

The  necessity  for  trained  nurses  and  the  difficulty  experi- 
enced in  securing  those  actuated  by  a  philanthropic  spirit 
led  to  the  establishment  in  1869  of  the  Westphalian  Mother- 
house  of  Deaconesses  as  one  of  the  departments  of  the 
colony.  In  this  department,  called  Sarepta,  girls  and 
young  women  are  trained  to  become  nurses,  teachers  of  the 
young,  and,  in  fact,  to  be  ready  to  undertake  whatever  cir- 
cumstances may  demand  in  their  sphere  of  work.  At  the 
head  of  Sarepta,  besides  two  clergymen,  are  a  deaconess- 
mother  and  a  probation-mistress  for  the  training  of  the  pro- 
bation sisters.  All  those  desiring  to  undertake  the  duties 
of  an  evangelical  sister  are  informed  by  letter  that  the  life  of 
a  deaconess  is  one  of  daily  self-sacrifice  for  others.  A  few 
words  from  the  letter  addressed  to  each  applicant  are  suffi- 
cient to  show  the  spirit  in  which  she  is  expected  to  enter 
upon  her  duties:  "  Whoever  would  come  to  us  in  order  to 
make  a  name  for  herself  and  to  seek  earthly  honors ;  who- 
ever would  come  for  the  sake  of  being  provided  for  and 
without  love  for  the  work,  would  lack  strength  of  endurance 
and  be  in  danger  of  suffering  injury  to  her  soul.  But  who- 
ever, after  earnest  self-examination,  believes  to  see  the  will 
of  God  and  His  guiding  hand,  and  sets  her  hope  in  a  merci- 
ful God  and  His  help,  and  desires  to  enter  the  work  in  that 
spirit,  she  will  learn  that,  although  life  spent  in  the  service 
and  imitation  of  the  Master  in  this  work  is  full  of  weariness, 
it  is  also  full  of  joy." 

The  age  of  applicants  may  range  from  eighteen  to  forty 


232  CARE  AND    TREATMENT  OF  EPILEPTICS. 

years.  They  must  possess  good  physical  health  and  an 
unblemished  reputation.  The  necessary  degree  of  educa- 
tion is  shown  by  an  account  of  the  applicant's  life  written 
by  herself.  Young  women  who  are  found  eligible  enter  the 
so-called  "  ante-probationary  "  class  and  work  for  a  time  in 
the  mother-house  without  distinctive  dress.  If  it  is  thought 
during  this  period  that  they  are  suited  for  the  Sisterhood, 
they  are  given  the  cap  of  a  probation  sister  on  the  occasion 
of  one  of  the  monthly  "  Sisterhood  Days."  The  period  of 
probation  lasts  usually  at  least  one  year,  during  which  the 
probationers  receive  only  free  board  and  lodging.  After 
this  time,  if  there  is  good  reason  to  believe  them  equal  to 
the  duties  of  full  sisterhood,  they  are  admitted  into  the 
class  of  Assistant  Sisters.  From  that  time  they  are  pro- 
vided with  clothing  and  pocket-money.  They  are  also 
sent  to  other  homes  for  further  practical  training.  As  a 
rule,  they  are  recalled  in  the  fourth  or  fifth  year  to  the 
mother-house,  in  order  that  they  may  receive  instruction 
in  any  department  of  work  in  which  their  training  may  have 
been  deficient.  They  usually  do  not  obtain  full  sisterhood 
until  five  years  have  been  passed  in  the  service  of  the  order, 
and  never  until  the  completion  of  their  twenty-fifth  year. 
The  admission  into  the  Sisterhood  is  consecrated  by  a 
special  church  service,  and  occurs  at  the  time  of  the  annual 
celebration  in  the  mother-house. 

In  the  formation  of  unselfish  Christian  character  and  the 
development  of  useful  talent,  Sarepta  has  been  eminently 
successful.  With  an  education  diverse  in  its  application, 
the  monotony  incident  to  the  routine  of  a  particular  line  of 
duties  is  not  experienced  ;  but  relaxation  and  renewed  vigor 
are  often  derived  from  a  change  of  occupation.  Of  the 
hundreds  of  sisters  educated  at  Sarepta  many  are  now  in 
other  useful  fields  of  labor  in  Germany  and  foreign  lands. 


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BETHEL    COLONY.  233 

As  a  complement  to  the  mother-house,  Nazareth,  the 
home  of  the  deacons,  was  established  in  1877.  The  deacons 
are  educated  as  nurses  and  evangelists,  and  may  be  carpen- 
ters, blacksmiths,  or  farmers;  or  they  may  have  other 
trades  or  occupations.  If  their  services  are  not  required 
at  Bethel  or  the  colonies  connected  therewith,  they  are 
sent  to  other  homes  and  to  foreign  mission  fields. 

There  are  eleven  medical  men — seven  chief  physicians 
and  four  assistants — and  six  pastors  connected  with  the 
colony.  Pastor  von  Bodelschwingh  says:  "  The  physician 
takes  upon  himself  a  regular  medical  treatment,  and  a  con- 
scientious personnel  of  house-parents,  brothers,  and  sisters, 
with  all  their  ability,  carry  out  his  dietetic  and  medical 
prescriptions." 

Stress  is  laid  upon  the  desirability  of  classifying  the  pa- 
tients into  single  family  groups,  of  open-air  labor,  health- 
ful food,  regular  exercise,  and  personal  cleanliness.  The 
inmates  are  separated  into  120  families  with  from  ten  to 
twenty  in  a  family.  These  are  distributed  in  upwards  of 
fifty  houses;  many  of  the  houses  containing  but  one  family, 
a  few  of  the  dwellings  containing  several  groups.  The  care 
of  these  requires  a  personnel  of  about  70  house-parents,  84 
deacons,  69  deaconesses,  and  19  assistants.  There  is  an 
average  of  one  nurse  to  between  seven  and  eight  patients. 
The  house-parents  live  with  the  patients,  working  with  them 
and  superintending  the  domestic  affairs  with  diligence  and 
devotion.  They  show  the  patients  how  to  perform  their 
tasks,  and  are  to  them  friend,  brother,  sister,  even  father 
and  mother.  The  home  element  is  therefore  introduced 
into  every  dwelling.  The  deacons  and  deaconesses,  as  also 
the  house-fathers  and  house-mothers,  receive  no  compensa- 
tion other  than  their  own  support  and  what  is  termed 
pocket-money,   but  are  cared  for  in  sickness  and  old  age. 


234  CARE  AND  TREATMENT  OF  EPILEPTICS. 

As  a  necessary  part  of  the  administration  of  such  a  col- 
ony, there  are  stewards,  overseers,  bookkeepers,  collectors, 
drivers,  and  other  persons  variously  employed,  who  reside 
in  the  colony  with  their  families. 

A  further  classification  of  the  inmates  is  observed,  based 
upon  their  mental  and  physical  condition  and  their  social 
standing.  According  to  their  ability  to  pay  for  their  sup- 
port there  are  four  classes.  First-,  second-,  and  third-class 
patients  are  charged  for  support  and  care  from  $iooto  $500 
each  per  annum.  Great  numbers  apply  for  admission  who 
are  not  wholly  dependent  and  cannot,  therefore,  be  com- 
mitted to  the  colony  by  public  authorities;  but  they  are  so 
close  to  the  line  of  dependency  as  to  make  them  objects  of 
commiseration.  If  there  is  room  for  them  they  are  ad- 
mitted free  or  at  such  rates  as  they  or  their  relatives  or 
guardians  are  able  to  pay,  the  principle  always  having  been 
observed  to  deny  no  epileptic  the  benefits  of  colony  life  if 
it  was  possible  to  receive  him. 

The  Provincial  Councils  contribute  to  the  maintenance  of 
such  patients  as  belong  to  the  class  of  the  wholly  dependent 
poor  the  daily  per-capita  allowance  of  one  mark  twenty 
pfennige,  or  about  two  dollars  a  week,  which  does  not  cover 
the  cost  of  support.  The  somewhat  dearer  price  of  food 
during  recent  years,  and  the  more  stringent  regulations  of 
the  Government,  which  place  epileptics  in  the  same  cate- 
gory with  the  insane  as  to  requirements  for  care,  have  made 
it  necessary  to  ask  the  provincial  authorities  to  increase 
the  allowance  to  one  mark  thirty  pfennige.  A  very  large 
proportion  of  the  expenses  of  the  colony  is  met  by  volun- 
tary contributions.  Many  gifts  of  charity  are  sent  without 
special  request,  especially  at  Christmas  time,  and  consider- 
able sums  are  collected  by  children's  societies.  The  liberal- 
ity manifested  in  all  ranks  and  conditions  of  society  towards 


i       «*                        1 

I                                    ft  .. 

r    fl 

.,, 'H-ii-if1 

mtiORUI 

1 

i|l 

-     •» 

• 

EBENEZER   'Bethel  Colony  I 


BETHEL    'Bethel  Colony". 


MAMRE-    FARM    RESIDENCE    FOR    EPILEPTICS. 


BETHEL    COLONY.  2$$ 

this  great  and  useful  charity  shows  a  spirit  of  philanthropy 
full  of  hopefulness  for  suffering  humanity. 

Institutions  for  epileptics  and  for  the  insane  are  under  the 
supervision  of  a  special  commission  appointed  by  the  Gov- 
ernment, and  they  are  also  frequently  inspected  by  the  dis- 
trict physician. 

One  of  the  most  noteworthy  characteristics  of  the  colony 
is  its  industrial  system.  Even  patients  of  the  first  class,  who 
pay  a  high  price  for  care,  are  not  released  from  a  share  in  the 
labor.  No  one  enjoying  a  fair  degree  of  physical  health  is 
allowed  to  pass  his  time  in  idleness.  Weather  permitting, 
patients  are  preferably  given  outdoor  employment  at  farm- 
ing, gardening,  taking  care  of  stock,  raising  fruit,  seeds, 
etc.  There  are  some  twenty  shops  and  departments  for 
indoor  work,  which  includes  printing  and  bookbinding, 
boot-  and  shoe-making,  and  cabinet-work;  also  tailoring, 
saddlery,  and  basket-making.  In  the  iron  foundry,  tin- 
shop,  and  blacksmith's  shop,  many  patients  are  profitably 
employed.  Brick-making  is  an  important  industry.  In 
fact,  a  great  variety  of  indoor  and  outdoor  work  is  here 
followed,  as  in  an  ordinary  village,  even  to  the  conducting 
of  a  post-office,  which  is  in  charge  of  an  epileptic.  Employ- 
ment for  women  consists  largely  in  household  work,  needle- 
work, and  gardening. 

A  family  of  carpenters  live  in  a  house  called  Little 
Nazareth.  The  head  of  this  family  is  a  house-father,  who 
is  a  carpenter,  a  trained  nurse,  and  an  evangelist.  To  him 
and  his  wife  is  committed  the  daily  physical  and  spiritual 
welfare  of  the  carpenter  family.  Each  house  has  a  staff  of 
brother  deacons  at  work  among  the  patients,  acting  as  fore- 
men and  sleeping  in  the  night  wards.  So  perfectly  is  the 
lost  family  life  restored  and  so  homelike  are  the  conditions 
of  the  patients,  that  Pastor  von  Bodelschwingh  says:  "  One 


236  CARE  AND  TREATMENT  OF  EPILEPTICS. 

who  goes  through  the  great  number  of  our  workshops  and 
finds  throughout  them  the  patients  at  their  labor,  will  never 
get  the  impression  that  he  is  in  an  asylum  for  the  sick;  and 
it  is  only  the  couches  placed  in  the  workshops  for  patients 
who  break  down  that  remind  one  that  there  is  anything  un- 
usual here.  Even  our  schools,  so  far  as  they  do  not  contain 
weak-minded  epileptic  children,  are  scarcely  distinguishable 
from  the  usual  elementary  schools." 

The  useful  employment  of  the  patients,  particularly  in 
the  occupations  to  which  they  have  been  accustomed,  is 
continually  emphasized  by  the  physicians.  Of  the  desira- 
bility of  labor,  Dr.  Warnek  says:  "  The  blessing  of  labor  to 
our  epileptics  is  unmistakable.  It  diverts  their  thoughts  to 
other  circles  of  ideas,  and  its  performance  diverts  the  mind 
from  ill  temper  and  the  practice  of  bad  habits.  Those  pa- 
tients who  are  still  in  a  condition  to  work  feel  better,  and 
are  less  excited  and  irritable.  The  hours  for  labor  are  so 
arranged  as  to  leave  time  for  recreation,  for  walking  in  the 
gardens  and  in  the  woods,  playing  in  the  open  air,  and  for 
excursions.  Winter  naturally  brings  a  contraction  of  these 
privileges  and  makes  returnable  a  large  number  of  attacks 
among  the  inmates  of  the  houses." 

The  daily  routine  is  as  follows :  The  patients  rise  at  an 
early  hour  and  are  served  with  a  breakfast  of  bread  and 
butter  and  coffee  at  6.30.  About  two  hours  later  the  house- 
father conducts  family  worship,  which  is  followed  at  nine 
o'clock  by  a  breakfast  similar  to  the  first.  Dinner  is  served 
at  noon,  consisting  of  soup,  roast  beef  or  veal,  two  kinds  of 
vegetables,  bread  and  butter,  with  stewed  or  baked  apples, 
stewed  prunes,  pears,  or  peaches.  The  rules  respecting  diet 
are  very  strict.  No  pies,  pudding,  pastry,  or  sweetmeats 
of  any  kind  are  allowed.  At  4  P.M.,  a  fourth  meal  is  served, 
made  up  of  bread,  plain  or  toasted,  with  butter  and  coffee. 


ARIMATHEA  — COTTAGE    FOR    11    EPILEPTIC    PATIENTS    <  Bethel  ColonyJ. 


BRICK    AND    TILE    WORKS    ("Bethel  Colony  >. 


REHOBOTH  —  FARMHOUSES. 
FOR    EPILEPTIC    COLONISTS.    AT    ftll  HFl  MSDORF.    BRANCH    OF    BETHEL    COLONY. 


BETHEL    COLONY.  237 

From  four  o'clock  until  seven  the  patients  are  at  liberty  to 
amuse  themselves  as  they  please  by  walking,  playing  at 
games,  engaging  in  harmless  pastimes,  or  reading.  The 
supper  at  seven  consists  of  bread  and  butter  and  weak  tea. 
For  special  cases  cheese  or  sausage  and  occasionally  hot 
boiled  rice  or  macaroni  are  allowed.  After  supper  the  house- 
father again  conducts  family  worship  in  the  sitting-room  of 
the  home.  A  musical  instrument,  of  which  there  is  one  in 
each  house,  is  brought  into  requisition  in  this  simple  service. 
Nine  o'clock  is  the  retiring  hour.  In  the  intervals  between 
the  meals  from  five  to  seven  hours  are  devoted  to  labor  ac- 
cording to  the  capacity  and  strength  of  the  patient.  Vari- 
ous kinds  of  amusements  and  simple  entertainments  are 
provided  for  the  evening.  Children  under  fifteen  years  of 
age  and  capable  of  learning  are  instructed  four  hours  daily 
in  the  schoolroom  by  deacons  and  deaconesses. 

A  new  "  cell  house  "  for  temporarily  insane  females  was 
completed  in  1895,  of  which  the  management  says:  "  It  is 
a  great  relief  to  us  that  by  means  of  this  building  we  are  in 
a  position  to  isolate  quickly  excited  and  insane  female  pa- 
tients and  also  prevent  excitement  in  other  patients  and 
possible  acts  of  violence.  This  isolation  is  also  necessary 
for  the  protection  and  curing  of  the  sick  themselves,  as  in  a 
state  of  high  excitement  attempts  at  self-destruction  are  not 
rare.  Shut  up  in  a  cell  and  resting  in  bed,  the  excited  pa- 
tient soonest  becomes  quiet.  Many  ask  for  temporary  iso- 
lation themselves  when  threatened  with  approaching  periods 
of  excitement.  This  is  an  indication  to  us  that  it  is  not 
best  to  allow  patients  to  reach  a  highly  excited  condition 
before  giving  them  the  benefit  of  seclusion  and  rest  in  bed. 
The  necessity  of  this  isolation  is  shown  by  the  following 
figures.  In  the  House  Bethel  there  have  been  isolated  in  so 
short  a  period  as  six  months  :  eight  on  account  of  attempts 


238  CARE  AND    TREATMENT  OF  EPILEPTICS. 

at  suicide;  twenty  on  account  of  delirium;  seventeen  on 
account  of  confusion  of  mind ;  fifteen  on  account  of  deeds 
of  violence." 

Among  other  recent  improvements  at  the  colony  is  an 
assembly-hall  with  seating  room  for  nearly  1500  persons. 
For  years,  Christmas  presents  and  other  gifts  had  been  laid 
aside  in  order  to  prepare  a  suitable  place  of  entertainment 
for  the  patients.  The  arrangement  of  the  hall  is  such  that 
the  more  feeble  ones  are  admitted  by  separate  entrances. 
The  large  flat  roof  of  the  building,  provided  with  a  high 
balustrade  and  embellished  with  shrubs  and  flowers,  affords 
a  refreshing  and  healthful  retreat  and  place  of  amusement 
to  certain  female  patients  formerly  confined  to  a  small  gar- 
den. A  new  bath-house  has  also  been  recently  constructed. 
By  means  of  the  addition  of  a  more  powerful  engine,  the 
electric  system  has  been  extended  so  as  to  include  the 
operating  of  an  electric  tramway  for  bringing  the  clay  from 
its  natural  deposit  to  the  brickyard. 

Although  Bethel  Colony  has  been  severely  criticised  in 
some  quarters,  on  account  of  the  specifically  religious  char- 
acter of  the  institution,  it  must  nevertheless  be  admitted  on 
all  sides  that  the  self-sacrificing  work  accomplished  there 
has  been  of  incalculable  benefit  to  humanity,  and  that  in 
the  development  of  this  grand  charity  Pastor  von  Bodel- 
schwingh  and  his  co-laborers  have  displayed  extraordinary 
courage,  wisdom,  and  devotion. 

The  two  provinces  of  Rhineland  and  Schleswig-Holstein, 
having  had  it  in  view  to  erect  their  own  asylums  for  epilep- 
tics instead  of  sending  them  to  the  Bethel  Colony  near  Biele- 
feld, appointed  deputies  to  visit  that  institution  and  make 
report  as  to  the  best  method  to  be  pursued.  The  commit- 
tee from  Rhineland,  which  was  commissioned  to  ascertain 
if  patients  of  the  Rhine  Province  could  not  be  settled  upon 


BETHEL    COLONY.  239 

a  great  farm  in  Hunsruck,  came  to  the  conclusion  after  a 
careful  inspection  of  the  colony  that  such  care  as  could  be 
provided  in  the  Rhine  Province  for  epileptics  would  be  far 
inferior  to  that  offered  at  Bielefeld. 

The  committee  from  the  province  of  Schleswig-Holstein, 
which  visited  the  institution  in  March,  1897,  reported  that 
Bethel  was  unsurpassed  in  its  numerous  possibilities  for 
caring  for  and  employing  patients.  The  fears  entertained 
in  some  quarters  that  the  size  of  the  institution  interfered 
with  individual  treatment  were  dispelled  by  the  unique  plan 
of  Bielefeld.  It  was  reported  that  danger  from  unsanitary 
conditions  common  to  large  institutions  was  overcome  by 
the  favorable  location  of  the  buildings,  which  are  scattered 
over  the  wooded  hill  and  through  the  valleys  lying  on  both 
sides,  so  that  the  inmates  not  only  have  an  abundance  of 
light  and  fresh  air,  but  salutary  prospects  of  beautiful  sur- 
roundings. The  conclusion  was  reached  that  better  care 
could  not  be  provided  for  epileptics  than  that  secured  at 
Bethel  by  the  harmonious  co-operation  of  the  skilled  medi- 
cal men,  the  faithful  spiritual  leaders,  and  the  excellent  corps 
of  trained  attendants. 

Of  the  good  work  that  has  been  accomplished  at  Bethel 
Pastor  Siebold  says : 

"  In  the  course  of  thirty-one  years  there  has  very  gradu- 
ally been  formed  here  a  community  of  3500  souls,  including 
the  officers,  attendants,  and  employees.  In  this  colony 
many  pitiable  human  beings  lead  a  comparatively  happy 
and  contented  life  If  we  could  measure  the  degree  of 
earthly  happiness  by  the  measure  of  thankfulness,  our  epi- 
leptic settlement  would  belong  to  the  most  fortunate  places 
in  our  fatherland.  There  are  many  sighs  and  lamentations 
changed  into  songs  and  hymns  of  thanksgiving.  Many 
homeless  ones  have  found  again  a  home  and  in  many  ways 


240  CARE  AND    TREATMENT  OF  EPILEPTICS. 

a  family  life.  Laborers  without  employment  have  here 
been  able  to  return  to  the  calling  that  was  dear  to  them, 
and  to  enjoy  a  sense  of  independence  which  comes  from  self- 
support,  although  in  many  instances  they  overestimate  the 
pecuniary  value  of  their  services.  Severe  suffering  is  here 
alleviated ;  milder  and  less  frequent  attacks  take  the  place 
of  the  powerful  shocks  which  so  soon  lead  to  idiocy ;  and  a 
small  number — from  seven  to  eight  per  cent. — are  entirely 
healed,  or  so  far  improved  as  to  return  to  the  ordinary  duties 
and  occupations  of  life.  If  suddenly  returning  attacks  for 
a  time  cause  discouragement,  there  still  remains  to  the  ma- 
jority of  our  patients  the  fundamental  frame  of  mind — '  We 
are  on  the  way  to  recovery. '  Here  everything  is  entirely 
different  from  the  world  outside.  Their  well-being  and 
comfort  are  the  first  consideration.  For  them  the  bells  are 
rung  for  church ;  for  them  the  doors  to  schools  and  work- 
shops open ;  for  them  are  also  prepared  pleasures  to  which 
they  are  summoned  by  the  sound  of  the  trumpet,  whether 
a  national  festival  is  to  be  celebrated  or  a  walk  taken  through 
the  woods  of  the  Teutoburger  mountains. 

"  So  far  does  the  care  here  ameliorate  the  suffering  of  the 
patients  that  most  of  them  can  enjoy  a  dignified  human  ex- 
istence and  many  can  perform  gladdening  and  animating 
labor,  while  nearly  all  have  the  consciousness  that  they  are 
not  useless  in  the  world.  But  when  earthly  hopes  gradually 
fail,  then  have  we  still  the  joy  to  find  in  the  greater  part  of 
our  patients  a  resignation  to  God's  will,  vvhich  lightens  every 
sickness,  and  a  peaceful  readiness  to  enter  the  way  into  the 
Valley  of  the  Shadow  of  Death." 


INDEX 


Abrahams,  Mrs.  Woodward,  162 
Accommodations  for  Officers  and  Em- 
ployees, 43 
Administration  Building,  43 
Age,  8,  85,  193,  230 
Aix-la-Chapelle,  214 
Alexander,     Dr.    William,   190,    191, 

195 

Alexianer  Brothers,  214 

Alt-Scherbitz  Asylum,  34,  36 

Ash,  Rev.  J.,  159 

"  Asile  de  la  Teppe,"  213 

Assembly-Room,  42 

Association  for  the  Study  of  Epi- 
lepsy, 60 

Attendants,  Training  of,  56 

Awakening  Interest,  62 

Baldwinville,  Mass.,  143 

Barker,  Dr.  P.  C,  145 

Barr,  Dr.  Martin  W.,   161 

Bayard,  Hon.  Thos.  F.,  199 

Bayard,  Mrs.  Thos.  F.,  200 

Beaton,  Dr.  A.  H.,  188 

Benoit,  Dr.  Marie  Louise,  120 

Bergamo,  Italy,  216 

Berlin,  Prussia,  215,  216 

Bethel  Colony  near  Bielefeld,  226 ; 
establishment  of,  population,  situ- 
ation, government  and  manage- 
ment, 227 ;  acreage,  number  of 
patients,  nationality  of  patients, 
228  ;  record  of  seizures,  patients 
received  since  opening,  229  ;  men- 
tal condition  and  age  of  patients, 
230  ;  Westphalian  Mother-house  of 
Deaconesses,  Sarepta,  evangelical 
sisterhood,  231  ;  Nazareth,  dea- 
cons, medical  men,  classification  of 
patients,  233  ;  maintenance  of  pa- 
tients, 234  ;  governmental  super- 
vision, industrial  system,  235  ;  daily 
routine,  236 ;  temporarily  insane 
patients,  237 ;  assembly-hall,  re- 
ports of  committees  of  Rhine- 
land  and  Schleswig-Holstein,  238  : 
good  work  accomplished,  239 


Biddle,  Cadwalader,  152 
Bielefeld,  Westphalia,  226 
Biesdorf,  Prussia,  216 
Blackford,  Dr.  Benjamin,  187 
Bodelschwingh,  Pastor  Friedrich  von, 

15,  20,  214,  227,  228,  233,  238 
Borden,  Rev.  Mary  J.,  14 
Bost,  Pastor  John,  210-213 
Brinkerhoff,  Gen.  R.,  66,  68,  70 
Brown,  Dr.  Sanger,  22 
Brown,  H.  E.,  95 
Browne,  Sir  James  Crichton,  196 
Buckley,  Rev.  James  M.,  149 
Buildings  :  character  of,  variety  of,  33 ; 
cottage  groups,  covered  ways,  34  ; 
size   of,     cellars,    35  ;    workshops, 
kitchens,    laundries,    36  ;    material 
of,    37 ;   heating,    ventilation,    38  ; 
fireplaces,    unplastered  walls,    39 ; 
color  of,  40 ;  Hospital  and  Infirm- 
ary Accommodation,  Provision   for 
Patients  Temporarily  Irresponsible, 
Assembly-Room,    42  ;    Administra- 
tion Building,  Accommodations  for 
Officers   and    Employees,    Labora- 
tory and  Morgue,  43 
Bullard, Dr.  William  N.,  20,61,136,137 
Bunnelle,  Hon.  Geo.  H.,  69 
Business  principles,  33 
Byers,  Dr.  A.  G.,  64,  66,  68,  70 

California  :  establishment  of  the 
California  Home  for  the  Care  and 
Training  of  Feeble-Minded  Chil- 
dren, State  control,  first  appropria- 
tion, site  changed  to  Santa  Clara, 
deficiency  of  land,  purchase  of 
large  acreage  at  Eldridge,  168  ;  The 
Institution  Bulletin,  beginning  of 
State  care  for  epileptics,  169  ;  sep- 
arate department  for  epileptics, 
170  ;  plan  of  development,  statutory 
provision  affecting  epileptics,  171  ; 
epileptic  population,  regularity  a 
fundamental  principle,  173  ;  em- 
ployment, dietary,  174  ;  education, 
175  ;  expenditure,  176 


241 


242 


INDEX 


Canada  :  advisability  of  colony  care 
under  consideration,  recommen- 
dation of  the  Ontario  Medical  As- 
sociation, 188 

Carson,  Dr.  James  C,  12 

Chalfont  St.  Peter,  England,  198 

Chamberlain,  T.  F.,  188 

Charity  Organization  Society  (Lon- 
don), 195 

Chippewa  Falls,  Wis.,  178 

Christiania,  Norway,  216 

Clark,  Dr.  L.  Pierce,  120,  121,  132 

Clark,  Sir  Andrew,  196 

Classification,  40 

Climatic  Influences,  13 

Coffin,  E.  Luella,  131 

Colonizing  epileptics,  20 

Compensating  Patients,  55 

Connecticut :  report  of  trustees  of 
Connecticut  Hospital  for  the  In- 
sane, proposition  to  establish  colo- 
ny near  New  Haven,  184 

Continental  Countries  :  progress  of 
work  in  Germany,  special  institu- 
tions, 209  ;  development  of  asylum 
care,  origin  of  first  colony  on  the 
cottage  plan,  210  ;  institutions  in 
France  and  Germany,  213  ;  State 
care,  215  ;  Wuhlgarten  (see  W)  ; 
Switzerland  (see  S)  ;  Bethel  Colony 
(see  B) 

Copenhagen,  Denmark,  216 

Copp,  Dr.  Owen,  143 

Cortical  Epilepsy,  5 

Cottage  groups,  arrangement  of,  34 

Cottages,  34,  36 

Covered  ways,  34,  35 

Cox,  Henry,  191 

Coxe,  Eckley  B.,  Jr.,  154 

Coxe,  Rebecca,  154 

Craig  Colony :  location,  description 
of  site,  100 ;  East  group,  Letch- 
worth  House,  102  ;  The  Inn,  The 
House  of  the  Elders,  Hoyt  Cot- 
tage, Tall  Chief  Cottage,  103  ;  The 
Elms,  schoolhouse,  storehouse,  ice- 
house, temporary  residence  of 
Superintendent,  administration 

building,  104  ;  Peterson  Hospital, 
105  ;  laboratory  and  mortuary,  106  ; 
West  group,  107  ;  farmstead  group, 
industrial  building,  power-house, 
108  ;  water-supply,  109  ;  sewerage, 
future  development,  no  ;  group 
for  women  and  children,  III ;  prin- 
ciple of  development,  Superinten- 
dent's residence,  laundry,  appeals 
for  admission,  114  ;  temporarily 
disturbed  cases,  115  ;    first  aim  in 


treatment,  116  ;  diet,  preparation 
of  food,  117  ;  methods  of  treat- 
ment, 118  ;  a  remarkable  case,  119  ; 
results  of  treatment,  120;  medical 
records,  patients  temporarily  ab- 
sent, 121  ;  supervision  of  domes- 
tic affairs,  122  ;  object  teaching, 
nurses,  123  ;  civil  service  examina- 
tion, compensation,  124  ;  training- 
school,  night-patrols,  employment, 
125  ;  portable  mattresses,  farm  pro- 
ducts, 129  ;  recreation  and  amuse- 
ments, 130  ;  education,  131  ;  Sloyd 
school,  manual  training,  health, 
133  ;  statistics,  legislative  appropri- 
ations, 134 

Craig,  Hon.  Oscar,  92,  95 

Curwen,  Dr.  John,  66 

Degeneracy,  Legislation  to  Arrest,  12 
De  Liefde,  210 
Denmark,  216 

Detwold,  Pauline  von  Lippe,  209 
Deutzer,  Sister  Catharine,  159 
Diet,  47,  80,  117,  174,  203,  226,  236 
Dining-rooms,  48,  80 
Dispensary  treatment,  22 
Drewry,  Dr.  William  F.,  14,  20,  184- 
1S7 

Echeverria,  10 

Economy,  33 

Edgerly,  Dr.  J.  F.,  154,  155 

Education,  48,  82,  123,  131,  175,  223 

Edwards,  Mrs.  Passmore,  200 

Edwards,  Passmore,  197,  199 

Eldridge,  Cal.,  168 

Electric  system,  46 

Elwyn,  Pa.,  160 

Emmaus :  location  of  home,  dedica- 
tion, 165  ;  buildings,  beneficiaries, 
treatment,  166 ;  branch  asylum, 
management,  how  supported,  167 

Employment,  53,  79,  125,  160,  162, 
166,  174,  179,   192,  206,  220,  223, 

235 

England  :  insufficient  provision,  189  ; 
epileptic  children,  committee  of 
Education  Department,  recom- 
mendation of  committee,  190  ; 
Manchester  and  Chorlton  colony, 
191  ;  Home  for  Epileptics,  Mag- 
hull  (see  H) ;  National  Society  for 
the  Employment  of  Epileptics  (see 
N)  ;  The  Meath  Home  of  Com- 
fort (see  M) ;  St.  Luke's  Home 
(see  S) 

Entertainment,  81,  130,  193,  220 


INDEX 


243 


Epilepsy,  Characteristics  of,  3  ;  Age 
at  which  Disease  Develops,  8 ;  expert 
treatment  of,  22 ;  scientific  study 
of,  23 

Epileptic  Degeneration,  6 

Epileptics,  neglect  of,  1  ;  Ratio  of,  to 
Population,  14  ;  number  of,  Lack  of 
Provision  for,  in  the  United  States, 
15  ;  in  institutions  for  the  feeble- 
minded, 16;  Reasons  for  Special 
Provision  for,  colonization  of,  20  ; 
dispensary  treatment  of,  22 

Farmstead,  46 
Fire,  Protection  against,  44 
Flood,  Dr.  Everett,  144 
Flower,  Gov.  Roswell  P.,  94,  95 
Food,    distribution  of,  34  ;   prepara- 
tion of,  47 
Foster,  Commissioner,  119 
Founding  Colonies,  24 
Froebel,  224 
Furniture,  40 

Gallipolis,  O.,  73 
Garrison,  Prof.  S.  Olin,  145,  149 
Gaskell.  G.  Penn,  14,  49,  190,  202 
Glenn,  John  M.,  161 
Godalming,  England,  205 
Grand  ma  I,  3 
Greg,  Margaret,  208 
Grounds,  Improvement  of,  30 
Gundry,  Dr.  Richard,  18 

Haarlem,  Holland,  216 

Hare,  Dr.,  8 

Hasse,  8 

Hatch,  Augustus  T.,  133 

Heating,  38,  39 

Heboid,  Dr.,  217.,  219-221 

Heredity,  9,  21,  24,  231 

Herter,  Dr.  C.  A.,  107 

Hildreth,  Dr.  John  S.,  22 

Hippocrates,  1 

Hirsch,  15 

Hochweitschein  Asylum,  214 

Holland,  216 

Holt,  Miss  Elizabeth  D.,  122,  123 

Home  for  Epileptics,  Maghull  : 
founding  of,  situation,  buildings, 
191  ;  how  governed,  number  of  in- 
mates, how  supported,  employment, 
192 ;  amusements  and  entertain- 
ments, religious  services,  results, 
193  ;  principles  of  treatment,  194 

Hospital  Accommodation,  42 

Hospital  Cottages  for  Children  at 
Baldwinville  :  objects  of  institution, 
classes  received,  State  aid,  govern- 


ment, 143  ;  medical  staff,  cost  of 
maintenance,  Hospital  Cottage 
Friend,  Woman's  Board,  occupa- 
tion   and   schooling,    144 ;  results, 

145 
Howe,  Dr.  Delia  E.,  57 
Hoyt,  Dr.  Charles  S.,  103 
Huntington,  W.  Va.,  180 

Idiopathic  Epilepsy,  5 

Illg,  Rev.  J.  D.,  167 

Illinois  :  epileptic  population  of,  182; 
opinion  and  recommendations  of 
Board  of  Public  Charities,  resolu- 
tion of  State  Medical  Society,  183  ; 
attempted  legislation,  184 

Infirmary  Accommodation,  42 

Insane  epileptics,  proportion  of,  5 

Iowa:  attempted  legislation,  opinions 
favoring  separate  care  of  epileptics, 
181 ;  Iowa  State  Medical  Society, 
Medical  Society  of  the  Missouri 
Valley,  182 

Irving,  Dr.  P.  A.,  187 

Italy,  216 

Jackson,  Dr.  Hughlings,  61 
Jacoby,  Dr.  George  W.,  90 

Karlshof  Asylum,  214 
Kiedrich,  Prussia,  215 
King's  Daughters,  161,  162 
Knight,  Dr.  G.  H.,  9,  10,  184 
Kolle,   Dr.   F.,  20,  41,  49,  50,  209, 

223,  225,  226 
Konigswartha,  Saxony,  214 
Kreuzhilfe  Asylum,  214 

Laboratory,  43 
Laforce,  France,  210 
Lapeer,  Mich.,  176 
Larnage,  Comte  de,  213 
Lea,  Henry  C,  154 
Leponte,  15 

Letchworth,  Commissioner,  92 
Loch,  C.  S.,  190,  196 

Maghull,  England,  191 

Maintenance,  Cost  of,  59 

Mandel,  8 

Mariahilf  Asylum,  214 

Marriage  of  epileptics,  II,  12 

Marthasville,  Mo.,  165 

Maryland  :  inadequate  provision  in 
increasing  interest  in  epileptics, 
161  ;  The  Silver  Cross  Home  for 
Epileptics  (see  S)  ;  Maryland 
Asylum  and  Training-School  for 
Feeble-Minded  (see  M) 


244 


INDEX 


Maryland     Asylum     and     Training- 
School   for  Feeble-Minded  :    loca- 
tion   of,    how   managed,    separate 
cottage   for   epileptics,    experience 
of  trustees,  163 
Mason,  Mrs.  John  Thomas,  162 
Massachusetts  :  Dr.   Bullard's  paper, 
136  ;  State  Medical  Society,    137  ; 
recommendation  of  Governor,  rec- 
ommendations  of   State    Board  of 
Lunacy    and    Charity,    legislation 
creating  hospital  for  epileptics,  138  ; 
Massachusetts  Hospital  for  Epilep- 
tics   (see   M)  ;    Hospital    Cottages 
for  Children  at    Baldwinville   (see 
H). 
Massachusetts    Hospital    for    Epilep- 
tics :  location   of,  government,  ad- 
mission, 139  ;  transfer,  maintenance, 
acreage,  140  ;  buildings,  water-sup- 
ply,   141  ;   sewage,    custodial   care, 
opening     hospital,     school,     trade 
instruction,  employment,  142 
Maxwell,  Dr.  J.  B.,  10,   183 
Meath,  Countess  of,   205,  207 
Meath  Home  of  Comfort :  history  of 
founding,  204  ;    location,    opening 
Home,  class  of  beneficiaries,  205  ; 
nurses,      employment,    underlying 
philanthropic  principles,  206 
Michigan  :  opening  of  Home  for  the 
Feeble-Minded  and  Epileptic,  acre- 
age,   policy   of  institution,    admis- 
sion, 176  ;  applications,  177 
Minnesota  :    report    of   State   Board 
of  Corrections  and  Charities,  sepa- 
rate care  recommended,  Minnesota 
School   for    Feeble-Minded,    177  ; 
cottage  for  epileptic  girls,  methods 
of    care,    opinion    of   Dr.     Rogers 
respecting  colonies,  178 
Missouri  :  action  of  the  State  Board 
of  Charities,   bill  to  establish  col- 
ony, 163  ;  object  of  colony,  appro- 
priation, government,   164  ;  admis- 
sion,    discharge,     transfer,      165  ; 
Emmaus  (see  E) 
Moncure,  Dr.  J.  D.,  187 
Morel,  Dr.  Jules,  15,  24,  209 
Morris,  Dr.  John,  14,  21 
Morton,  Dr.  Samuel  W.,  155 

Naming  institutions,  36 

National  Association  for  the  Study  of 
Epilepsy  and  the  Care  and  Treat- 
ment of  Epileptics,  The,  60 

National  Society  for  the  Employment 
of  Epileptics,  England  :  committee 
of  inquiry  of  the  Charity  Organiza- 


tion Society,  results  of  ■  the  com- 
mittee's work,  195  ;  public  meeting 
at  the  Mansion  House,  196  ;  resolu- 
tion to  establish  colony,  subscrip- 
tions to  purchase  farm,  government, 
objects,  how  supported,  197  ;  selec- 
tion of  farm,  first  building  erected, 
principles  of  management,  198  ; 
buildings,  199  ;  needs  of  epileptic 
boys,  201  ;  superintendence,  ad- 
mission, 202  ;  charge  for  treatment 
and  maintenance,  dietary,  employ- 
ment, 203  ;  religious  privileges, 
moral  influence,  204 

Needs  of  epileptics  unrecognized,  1 

Neinstedt,  Prussia,  215 

New  Jersey  :   legislative  commission, 

145  ;  report  of  commission,  legisla- 
tion defeated,  resolution  of  the 
Allopathic   State  Medical  Society, 

146  ;  legislation  secured,  147  ;  New 
Jersey  State  Village  for  Epileptics, 
(See  N) 

New  Jersey  State  Village  for  Epi- 
leptics :  location  of,  government, 
admission,  147  ;  police  jurisdic- 
tion, 148  ;  spirituous  liquors,  ap- 
propriation, plan  of  founders,   149 

New  York,  87 ;  reports  of  State 
Commissioner  in  Lunacy,  87,  88  ; 
report  of  State  Board  of  Charities, 
88  ;  colonizing  epileptics  in  Amer- 
ica, educating  the  public,  co-opera- 
tion of  the  State  Charities  Aid 
Association,  S9 ;  report  of  sub- 
committee of  the  State  Charities 
Aid  Association,  90  ;  legislation  in 
behalf  of  epileptics  defeated,  State 
Charities  Aid  Association  bill,  State 
Board  of  Charities  authorized  to 
select  site  for  colony,  action  of 
Superintendents  of  the  Poor,  rec- 
ommendation of  State  Commission 
in  Lunacy,  91  ;  appointment  of 
committee  of  State  Board  of  Chari- 
ties, preliminary  work  of  commit- 
tee, 92  ;  examination  of  sites  for 
colony,  United  Society  of  Christian 
Believers  (Shakers),  93  ;  conclusion 
of  committee,  report  of  State  Board 
of  Charities,  legislation  defeated, 
94  ;  desired  legislation  secured, 
naming  colony,  first  appropriation, 
organizing  act,  95  ;  objects  of  col- 
ony, administration,  96  ;  admission, 
97;  discharge,  transfer,  99  ;  custody, 
discipline,  100  ;  Craig  Colony  (see 
C) 

Norway,  216 


INDEX 


245 


Nothnagel,  S 

Nurses,  Training  of,  56 

Oakbourne,  Pa.,  153 

Ohio,  63  ;  reports  and  recommenda- 
tions of  State  Board  of  Charities, 
63-68  ;  reports  of  Dr.  Byers  on 
condition  of  epileptics,  64,  66,  68  ; 
legislative  action,  65  ;  joint  conven- 
tion of  Legislature  and  State 
Board  of  Charities,  67  ;  commission 
appointed  and  appropriation  made, 
site  selected  for  institution,  ap- 
pointment of  board  of  trustees, 
69 ;  Ohio  Hospital  for  Epileptics 
(see  O) 

Ohio  Hospital  for  Epileptics  :  laying 
corner-stone  of,  power  of  trustees, 
70 ;  admission,  71  ;  transfer,  cus- 
tody, discipline,  discharge,  resident 
officers,  72  ;  situation,  buildings, 
73;  furniture,  74;  electric  system, 
ventilation,  heating,  open  fires, 
laundry,  75  ;  industrial  department, 
laboratory,  schoolhouse,  76  ;  insane 
asylum,  stone  quarry,  77  ;  expendi- 
tures, future  buildings,  lighting, 
water-supply,  sewage,  7S  ;  indus- 
tries, conservatory,  manual-train- 
ing school,  79 ;  dining-rooms, 
regulation  of  diet,  80  ;  daily  routine, 
social  influences,  summer  picnics, 
entertainments,  81  ;  schools,  82  ; 
musical  instruction,  devotional  ex- 
ercises, Sabbath-school,  prayer- 
meetings,  83  ;  discipline, attendants, 
84 ;  statistics,  85  ;  cost  of  mainte- 
nance, 86 

Ohlmacher,  Dr.  A.  P.,  76 

Olpe,  Westphalia,  215 

Open  fires,  39 

Opening  a  Colony,  30 

Ordronaux,  Dr.  John,  87 

Organization,  28 

Osborne,  Dr.  A.  E.,  23,  39,   56,  169- 

173,176 
Owing's  Mills,  Md.,  163 

Palmer,  Elizabeth,  208 

Passavant  Memorial"  Homes  for  the 
Care  of  Epileptics:  history  of  found- 
ing, 156  ;  opening  Homes,  object, 
157  ;  capacity,  classes  of  patients, 
government,  158  ;  Sisters  in  charge, 
management,  methods,  159 ;  pro- 
ducts of  farm,  principles  governing 
the  institution,  160 

Passavant,  Rev.  W.  A.,  Jr.,  157,  160 

Passavant,  \V.  A.,  D.D.,  156,  157 


Pedigo,  Dr.  Lewis  G.,  187 

Pelmann,  8,  15 

Pennsylvania :  recommendation  of 
Lunacy  Committee,  recommenda- 
tion of  Board  of  Public  Charities, 
attempted  legislation,  152  ;  reasons 
for  establishing  State  institution, 
153 ;  The  Pennsylvania  Epileptic 
Hospital  and  Colony  Farm  (see  P) ; 
The  Passavant  Memorial  Homes 
(see  P) ;  The  Pennsylvania  Train- 
ing-School for  Feeble-Minded  (see 

Pennsylvania  Epileptic  Hospital  and 
Colony  Farm:  management  of,  how 
supported,  situation,  estate,  153  ; 
buildings,  when  opened,  Philadel- 
phia branch,  154 ;  applications  for 
admission,  occupation,  library,  mu- 
sic, Ladies'  Aid  Committee,  system 
of  care,  results,  155  ;  State  aid, 
156 

Pennsylvania  Training-School  for  Fee- 
ble-Minded Children  :  how  sup- 
ported, 160 ;  epileptic  department, 
system  of  care  and  treatment,  161 

Perry,  Miss  Mary  E.,  164 

Peterson,  Dr.  Frederick,  3,  14,  20, 
61,  89-91,  94,  95 

Petit  mal,  3 

Popular  remedies,  2 

Port  Deposit,  Md.,  161 

Potsdam,  Prussia,  215 

Powell,  Dr.  F.  M.,  14,  16,  21,  49, 
181,  182 

Private  Benevolence,  Co-operation 
with,  25 

Provision  for  epileptics  in  the  United 
States,  Lack  of,  15 

Psychical  Epilepsy,  6 

Racial  Differences,  13 

Rash,  Sister  Lena,  159 

Rastenburg,  East  Prussia,  214 

Rath,  Prussia,  214 

Ratio  of  Epileptics  to  Population,  14 

Reflex  Epilepsy,  5 

Reimer,  Dr.,  213 

Relation  of  the  Epileptic  to  Society, 

17  , 
Religious  Worship,  58 
Rembe,  Dr.  E.  A.,  167 
Rochester,  Pa.,  157 
Rogers,  Dr.  A.  C,  178 
Rolle,  Switzerland,  222 
Rotenburg,  Prussia,  214 
Ruffner,    Mrs.    Mary   Jackson,    179, 

180 
Russia,  216 


246 


INDEX 


Rutter,  Dr.  H.  C,  20,  61,  62,  66-68, 

70,  72,  75,  76,  79,  8o,  83,  86 
Rutter,  Mrs.  H.  C,  72 

Sanborn,  F.  B.,  6 

Schloss  Tschugg,  Switzerland,  222 

Schnake,  Rev.  C.,  166 

Scientific  Knowledge,  Progress  in,  2 

Seguin,  Dr.  Edwin,  210 

Sewerage,  45,  78,  no,  142 

Sharp,  Dr.  A.  E.,  120 

Siebold,  Pastor,  209,  239 

Siemerling,  6 

Silver  Cross  Home  for  Epileptics  :  sit- 
uation of,  King's  Daughters,  161  ; 
gift  of  homestead,  opening  Home, 
how  supported,  treatment,  162  ; 
financial  condition,  163 

Sinkler,  Dr.  Wharton,  20,  156 

Sister  Amalie,  157,  159 

Sister  Martha,  157,  159 

Site,  Selecting  a,  26 

Skillman,  N.  J.,  147 

Sonyea,  N.  Y.,  93,  100 

Special  Provision,  Reasons  for,  20 

Spratling,  Dr.  William  P.,  20,  48,  53, 
60,  115,  116,  n8,  120,  123,  125- 
127,  131 

Spratling,  Mrs.  William  P.,  116,  131 

State  care,  24,  25 

State  Charities  Aid  Association  (New 
York),  91,  94,  95 

Status  Epilepticus,  4 

Stetten,  Wurtemberg,  213 

Stettin,  Prussia,  214 

Stewart,  Hon.  William  R.,  61 

St.  Charles,  Mo.,  167 

St.  Luke's  Home  :  location  of,  207  ; 
how  directed  and  supported,  208 

St.  Petersburg,  Russia,  216 

Sturm,  Rev.  C.  F.,  166 

St.  Valentine's  Home,  215 

Superstitious  beliefs,  1 

Sweden,  216 

Switzerland:  asylums  at  Zurich,  Rolle, 
and  Schloss  Tschugg,  how  governed 
and  supported,  buildings  and  ca- 
pacity, 222 ;  Zurich  Asylum  (see 
Z) 

Tabor  Asylum,  214 

Tain,  France,  213 

Texas:  Dr.  White's  paper,  committee 
of  State  Medical  Association,  149  ; 
recommendation  of  Governor,  ac- 
tion of  Legislature  establishing  col- 
ony, 150  ;  selection  of  site,  151 


Thorn,  J.  Pembroke,  163 

Tigges,  8 

Tilbeck,  Westphalia,  214 

Uchtspringe,  Prussia,  215 
Unplastered  walls,  39 

Vance,  Gen.  John  L.,  69,  70 

Van  Gieson,  Dr.  Ira,  2,  61,  107 

Ventilation,  38 

Virginia,  184 ;  Dr.  Drewry's  paper, 
appointment  of  legislative  commis- 
sion, 185  ;  committee  of  State  Medi- 
cal Society,  report  and  recommen- 
dation of  commission,  186 

Voorhees,  Gov.  Foster  M.,  147 

Wadsworth,  Mrs.  Charles  F.,  135 

Waite,  Hon.  C.  C,  69 

Walrath,  Commissioner,  92 

Warnek,  Dr.,  230,  236 

Water-Supply,  44 

Webster,  Dr.  W.  J.,  76 

West  Virginia  :  legislation,  179  ;  selec- 
tion of  site  for  institution,  building 
for  epileptics,  Board  of  Managers, 
180 

White,  Dr.  F.  S.,  149,  150 

Wildermuth,  Dr.,  2,  5,  S,  n,  12,  20, 
209 

Wilhelmsro,  Sweden,  216 

William  III.,  2 

Wilmarth,  Dr.  A.  W.,  9,  179 

Wisconsin  :  appropriation  by  Legisla- 
ture, selection  of  site  for  a  home 
for  feeble-minded  and  epileptics, 
178  ;  buildings,  Dr.  Wilmarth's 
methods,  179 

Women  physicians,  30 

Workshops,  36 

Worsham,  Dr.  B.  M.,  151 

Wuhlgarten  :  establishment  of  institu- 
tion, 216  ;  how  supported  and  con- 
trolled, capacity,  buildings,  217  ; 
cottages  for  patients,  219  ;  employ- 
ment, entertainment,  education, 
charge  for  support,  medical  service, 
220 ;  methods  of  care  and  treat- 
ment, 221 

Wurtemberg,  213 

Wiirzburg,  Bishop  of,  209 

Zurich  Asylum  :  how  governed  and 
supported,  buildings  and  capac- 
ity, 222  ;  founding  of  institution, 
employment,  classification,  educa- 
tion, 223  ;  dietary,  results,  226 


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